The involved glands and their ducts should be inspected for stones. In the acute phase, the lymph nodes are enlarged and homogeneously enhance at CT. As caseation occurs, the nodes become centrally hypoattenuating and cystic, with perinodal fat stranding that is milder than what is seen with bacterial adenitis (Fig 15). In the emergency setting, CT of the neck is often performed to investigate symptoms of acute infection or inflammation or symptoms of aerodigestive tract compromise referable to the neck. Descending mediastinitis in a 50-year-old woman who recently underwent a dental procedure. Since the advent of the Haemophilus influenzae type B vaccine, there has been a dramatic reduction in epiglottitis cases among children. Note the thickening of the left platysma muscle (arrow). (a) Axial contrast-enhanced CT image shows left peritonsillar edema (arrows), consistent with tonsillitis. The oral cavity (black * in b) is obliterated. Thyroid nodules are commonly encountered at neck imaging. A peritonsillar abscess (PTA) or peritonsillar phlegmon develops following tonsillitis or pharyngitis and is the most common pediatric head and neck abscess (20). The vocal cords should be evaluated for signs of asymmetry, as paralysis may occur owing to compression of the recurrent laryngeal nerve (40). Children with epiglottitis generally are in respiratory distress when they present and are diagnosed at clinical or radiographic examination. The condition involving mastoid effusion in conjunction with septal erosion is referred to as coalescent mastoiditis (60). Knowledge of this complex anatomy is necessary when a mass or inflammatory process is identified, and a strategy for determining which structures are deviated and the direction of the deviations must be used to make a diagnosis or differential diagnosis. Sagittal contrast-enhanced CT image shows prevertebral edema (*). The parotid gland is the only salivary gland that contains lymph nodes. There is also enhancing subgaleal soft tissue (white arrow), consistent with phlegmon. These findings were confirmed at contrast-enhanced MRI (not shown). In adults who present with symptoms such as severe sore throat, dysphagia, and fever, with a more gradual onset, CT can be performed as the initial imaging investigation. (b, c) Sagittal (b) and axial (c) contrast-enhanced CT images in a 21-year-old man with epiglottitis show thickening of the epiglottis (arrow in b) and aryepiglottic folds (arrows in c). However, when a lymph node is greater than 1 … This may be a sign that … (b) Axial contrast-enhanced CT image obtained inferior to a shows continued extension into the mediastinum (white arrow) and a small left pleural effusion (white arrowhead). Figure 15. Retropharyngeal edema due to calcific tendinitis of the longus colli in a 71-year-old woman. Wooden foreign bodies have air attenuation in the acute phase and therefore are best detected by using lung windows, and they may mineralize and increase in attenuation with time (30). © 2021 Radiological Society of North America, Epidemiological profile of non-traumatic emergencies of the neck in CT imaging: our experience, Emergency imaging assessment of deep neck space infections, Imaging evaluation of the suprahyoid neck, Value of helical computed tomography in the management of upper esophageal foreign bodies, Imaging features of midface injectable fillers and associated complications, Usefulness of CT scans in malignant external otitis: effective tool for the diagnosis, but of limited value in predicting outcome, Clinical practice guideline: acute otitis externa, Clival osteomyelitis presenting as a skull base mass, Malignant external otitis: utility of CT in diagnosis and follow-up, Congenital cystic masses of the neck: radiologic-pathologic correlation, Branchial cleft anomalies: a pictorial review of embryological development and spectrum of imaging findings, Imaging of Patients with Head and Neck Cancer: From Staging to Surveillance, Chapter 2 Squamous Cell Carcinoma of the Head and Neck: Imaging Evaluation of Regional Lymph Nodes and Implications for Management, Soft tissue tumors of the head and neck: imaging-based review of the WHO classification. (a) Axial contrast-enhanced CT image (bone window) shows tympanomastoid opacification (*). At CT, cellulitis manifests as skin thickening and infiltration of the subcutaneous fat and is sometimes associated with abscess formation, which appears as a rim-enhancing fluid collection (Fig E1). Mediastinal masses also may be detected on neck CT scans. These glands are usually very small. Neck CT Scan with Contrast Unless contraindicated, intravenous contrast media is used when scanning the neck. Chong V. Cervical lymphadenopathy: what radiologists need to know. In comparison, the right parotid gland (black arrowhead) is normal. If the address matches an existing account you will receive an email with instructions to reset your password. Infection involving the orbits, paranasal sinuses, or temporal bones can spread to the intracranial compartment by means of bone dehiscence or through valveless diploic veins. The lymphadenopathy responds to antibiotic therapy, and response to treatment may be evaluated with serial CT. Iodine deficiency is an important cause of goiter worldwide, but it is uncommon in the United States. CT atlas of thoracic lymph node stations as defined by IASLC, with ambiguous regions designated as per El-Sherief et al. A comprehensive discussion of malignant lymphadenopathy is beyond the scope of this article and has been reviewed elsewhere (14,48). Under normal circumstances, the superior mediastinal fat should be homogeneous, without fat stranding or a pneumomediastinum. Finally, important information regarding the fluid status of the patient can be gleaned from an assessment of the lung apices. There is also bone dehiscence (black arrow) along the dorsal aspect of the petrous apex. Among the cranial nerves, the facial nerve is the most commonly affected owing to involvement at the stylomastoid foramen. The cutaneous and subcutaneous soft tissues include the skin, subcutaneous fat, and superficial muscles (eg, platysma muscle and facial expression muscles). (a) Axial nonenhanced CT image shows asymmetric soft-tissue thickening (white *) medial to the left mandibular ramus, as well as thickening of the left masseter muscle (black *). The mastoid air cells lie predominantly within the mastoid portion of the temporal bone but vary in extent considerably between individuals. Furthermore, although the patient may present because of symptoms that suggest non–life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. The rising incidence of adult acute epiglottitis and epiglottic abscess, Infections of the Neck and Pharynx in Children, Diagnosis of peritonsillar infections: a prospective study of ultrasound, computerized tomography and clinical diagnosis, Predictors of intratonsillar versus peritonsillar abscess: A case-control series, Aberrant internal carotid artery in the mouth mimicking peritonsillar abscess. A chronic form of invasive fungal sinusitis may occur in immunocompetent patients, in whom the condition progresses over months to years (57). Figure 14c. Axial contrast-enhanced CT image (b) obtained superior to a shows a stone (black arrow) in the distal portion of the dilated right submandibular duct (white arrows). Portions of the circle of Willis are typically included at CT examinations of the neck, and consequently, intracranial arterial abnormalities may be visualized. We begin by describing a protocol for CT of the neck. On CT images, the subcutaneous fat and muscular structures should have sharp definition without infiltration of the subcutaneous fat. Epidural abscess and subgaleal phlegmon in a 13-year-old boy. (a) Axial contrast-enhanced CT image (bone window) shows tympanomastoid opacification (*). Impacted chicken bone in a 78-year-old woman. 2014 1. Infection may spread into the periodontal or more distant tissues as a result of dental procedures such as tooth extraction (33). Figure 18. The above classification is not inclusive of several important nodal groups in the head and neck: Other classification systems include some of these regions, but a consensus approach has not been reached. (a) Axial contrast-enhanced CT image (bone window) shows left tympanomastoid opacification (*), as well as opacification and coalescence of air cells at the petrous apex (white arrow). Injectable filler agents such as collagen, silicone, and hyaluronic acid can mimic subcutaneous infection or inflammation, and this possibility should be considered when isolated subcutaneous infiltration or highly symmetric infiltration is detected (6). A PTA is an accumulation of pus in the loose tissue around the palatine tonsil. Normal epiglottis versus epiglottitis in two patients. A soft plaque (white arrow) causing mild luminal narrowing also is present at the carotid bulb, with possible enhancement of the adjacent vessel wall. In contrast, carotidynia is a poorly understood idiopathic condition characterized by neck pain and focal tenderness in the region of the carotid bifurcation. In comparison, the right parotid gland (black arrowhead) is normal. They can also be found in the junction linking the trachea and the bronchi. Comparing the side of the clinical symptoms with the contralateral side can be helpful in determining whether there is erosion of the mastoid septa. Accessory parotid tissue often can be seen along the course of its duct (Stensen duct) superficial to the masseter muscle. A bone will appear as a thin or flat radiopaque attenuating lesion lodged within the oropharynx, hypopharynx, or esophagus (Fig 8). Use caution when giving aspirin to children or teenagers. Then, for each item on the checklist, we describe the structures being evaluated and common (and some uncommon but important) pathologic conditions that are seen in the acute setting. Following a 60-second delay, an additional 40 mL of the agent is administered at 2 mL/sec for 20 seconds. Although acute conditions are identified incidentally, recognizing them can still be vital for management! Being Lemierre syndrome ( Figure E15 ) and it occurs when otitis media to. Challenging, primarily because of the skin or mucosa aortic arch and includes. 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ct of lymph nodes of the neck 2021