Necrotizing fasciitis of the neck and emphysematous osteomyelitis of sternoclavicular joint: a rare case and peculiar imaging findings

Emphysematous osteomyelitis accompanied by necrotizing fasciitis (NF) is a rare life-threatening condition requiring immediate recognition and aggressive management. We report a case of a 47-year-old male who initially presented to the Emergency Department (ED) with fever, shoulder pain, and leukocytosis. The patient was discharged with analgesics for presumed musculoskeletal pain after an unremarkable chest radiograph. Over the following days, he developed a progressive chest and neck erythema, prompting his return to the ED. Bloodwork revealed a progression of leukocytosis. Contrast-enhanced CT identified emphysematous osteomyelitis of the first rib with sternoclavicular joint infection, accompanied by extensive NF of the upper mediastinum and lower neck, necessitating multiple emergent surgical interventions. This case underscores the importance of early cross-sectional imaging in suspected osseous and deep soft tissue infections, as plain radiography may appear deceptively normal. It also highlights the radiology's pivotal role in assessing disease severity and guiding timely, potentially life-saving intervention.