Computed Tomography in the Evaluation of Pediatric Neck Infections

Abstract

In children, infections involving both the superficial and deep neck spaces are common. Children so affected typically present with fever, neck mass, neck stiffness, and, occasionally, airway compromise. Radiologic modalities used in the evaluation of neck infections include plain lateral neck radiography, ultrasound, computed tomography, and magnetic resonance imaging. All these modalities have proved useful in the treatment of such infections, specifically the decision to perform incision and drainage. The charts of 66 patients-33 with superficial and 33 with deep neck infections-were analyzed with respect to symptoms, signs, computed tomography findings, and need for surgical intervention. Computed tomography was not particularly helpful in superficial neck infections with regard to the decision to perform surgical drainage; however, it did localize and demonstrate the extent of infection. In deep neck infections we found a 92% correlation between computed tomographic evidence of an abscess and surgical confirmation of one. Contrast-enhanced computed tomography remains an excellent tool in the treatment of neck infections in children.

Lack of association of CT findings and surgical drainage in pediatric neck abscesses

“…Another explanation is that increased prevertebral soft tissue thickness could be relevant for retropharyngeal and parapharyngeal abscesses in particular; this subset was not studied separately. Overall, in the 32 patients who underwent surgical exploration in this series, purulence or fluid was found in 28 (88%), which is consistent with the findings of other authors [5,6]. Twenty-three patients had frank purulence and five patients had thin turbid fluid at the time of surgical intervention.…”

“…They concluded that the added expense of CT is superceded by the improved diagnostic yield and sensitivity [1]. Wetmore et al found a 92% correlation between CT findings of a deep neck abscess and the presence of purulence during surgical drainage [5]. Our study attempted to determine whether specific CT characteristics of neck abscesses would be useful in determining the need for surgical drainage.…”

Intravenous Antibiotic Therapy for Deep Neck Abscesses Defined by Computed Tomography

“…In differentiating deep neck abscesses from phlegmons, several large series have reported the false-positive rate to range from 8% to 25%. [7][8][9]21 Furthermore, Broughton 5 and Sichel et al 6 describe children who responded to treatment with intravenous antibiotics alone with significant CECT evidence of RAs defined by classic radiographic criteria of ring enhancement and large size. Many of the cases reported by Sichel and colleagues showed scalloped rim enhancement, thought by Kirse and Roberson 1 to be an important predictor of abscess formation.…”

Diagnosis and Management of Orofacial Infections: A Retrospective Study of 440 Patients

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