What does soft tissue gas indicate in a patient?

From the Guidelines

Soft tissue gas in a patient typically indicates a serious infection, most commonly gas gangrene (clostridial myonecrosis) or necrotizing fasciitis, which requires immediate medical attention as it can be life-threatening. The presence of gas is caused by gas-producing bacteria, particularly Clostridium species, which release gases as they metabolize tissue in an anaerobic environment. Other causes of soft tissue gas include recent surgery, trauma with air entry into tissues, or certain procedures like subcutaneous emphysema.

When soft tissue gas is detected on imaging, urgent surgical consultation is necessary, and treatment typically involves aggressive surgical debridement, broad-spectrum antibiotics (such as penicillin G 4 million units IV every 4 hours, clindamycin 900 mg IV every 8 hours, and potentially an aminoglycoside), and supportive care 1. Hyperbaric oxygen therapy may be considered as an adjunctive treatment in some cases. The mortality rate for these infections can be high, especially if treatment is delayed, which is why rapid diagnosis and intervention are crucial 1.

Some key points to consider in the management of soft tissue gas include:

• Prompt and extensive surgery, including debridement, is essential for source control 1.
• Broad-spectrum antibiotics should be given as soon as possible, ideally within the first 6 hours, and the duration of treatment can be between 7-14 days 1.
• Delayed first surgical intervention (more than 12 hours) is associated with higher mortality 1.
• The use of antimicrobial therapy is an adjuvant treatment and must be combined with early surgical debridement 1.
• Procalcitonin monitoring may be useful to guide antimicrobial discontinuation 1.

The characteristic crepitus (crackling sensation when touching affected tissue) may be present on physical examination, along with pain disproportionate to visible findings, skin discoloration, and systemic signs of infection 1. CT findings in necrotizing fasciitis correlate with the pathophysiology of the infection, causing soft tissue inflammation and liquefactive necrosis, and skin thickening, inflammatory subcutaneous fat stranding, and fluid or gas in the superficial or deep fascial planes are the typical CT findings 1.

From the Research

Soft Tissue Gas Indication

Soft tissue gas can indicate a severe complication in a patient, such as:

• Gas gangrene, a potentially lethal condition characterized by air accumulation in the soft tissues, often caused by bacterial infections 2, 3
• Necrotizing soft tissue infections (NSTI), which can lead to rapid patient deterioration and require urgent surgery 4, 5, 6
• Emphysematous cholecystitis, a rare condition where air accumulates in the gallbladder wall, which can lead to soft tissue gas gangrene 2

Causes of Soft Tissue Gas

The causes of soft tissue gas can be diverse, including:

• Bacterial infections, such as those caused by Clostridium species, although this is not always the case 3
• Trauma, iatrogenic injuries, infection, and inflammation 4, 5
• Non-traumatic conditions, such as emphysematous cholecystitis 2

Clinical Significance

The clinical significance of soft tissue gas can range from:

• Incidental and benign to aggressive infection requiring immediate surgery 4, 5
• Potentially lethal outcome if left untreated or if treatment is delayed 2, 6
• Importance of prompt evaluation and treatment to prevent fatal outcomes 2, 6