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A 32-year-old healthy woman was referred to our Emergency Department (ED) for concern
of a necrotizing soft tissue infection (NSTI). Two days earlier, she suffered a laceration
on the lateral aspect of her right ankle during a bicycle accident. She irrigated
it with an over-the-counter cleaning solution, and after noticing redness around the
wound, went to an urgent care center where radiographs revealed air in the soft tissue
near the laceration. Physical examination demonstrated a well-appearing woman who
was afebrile with normal vital signs. Her ankle had a small laceration with surrounding
erythema, obvious crepitus, and mild tenderness to palpation. Laboratory analysis,
including C-reactive protein and erythrocyte sedimentation rate, was unremarkable.
Her radiograph is seen in Figure 1.
Figure 1Plain radiograph of the right ankle. The arrow indicates the location of the subcutaneous
emphysema around the lateral malleolus.
