PMC7218154_01
A-B. Computed Tomography Angiogram of Right Upper Extremity upon ED arrival. Imaging showed patent radial, palmar arch, and ulnar artery without stenosis. Extensive subcutaneous, intramuscular, and vascular emphysema along with soft tissue edema was found throughout the hand, suggestive of myonecrosis. Gas was most prominently visualized along the dorsal and ventral aspects of the metacarpals of the (A) wrist and (B) hand. C. Physical exam finding on Day 6. Extensive ecchymosis, bullae, and dusky mottling on extremities. D. Preoperative Photos. Visual characteristics along with imaging were suggestive that below elbow amputation would sufficiently provide margins clear of infection for source control.
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Extensive subcutaneous and intramuscular emphysema was seen throughout the hand and wrist, extending proximally into the forearm, suggesting a necrotizing process (Fig. 1A, B). She was emergently transported to the operating room and underwent a below elbow amputation for source control (Fig. 1D). Physical exam on day 4 revealed the appearance of a grey, dusky discoloration of her left hand and of her toes bilaterally, with associated mottling (Fig. 1C).