Imaging assessment of deep neck spaces infections: an anatomical approach

Caprioli, Simone; Tagliafico, Alberto; Fiannacca, Martina; Borda, F; Picasso, Riccardo; Conforti, Cristina; Casaleggio, Alessandro; Cittadini, Giuseppe

doi:10.1007/s11547-022-01572-8

Cited by 4 publications

(5 citation statements)

References 36 publications

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“…The syndrome predominantly affects healthy adolescents and young adults, involving a typical presentation of protracted pharyngitis followed by fever, neck pain, and swelling. The causative pathogen, F. necrophorum , is isolated in most cases, but the incidence of polymicrobial infections is also significant [ 66 ]. The role of imaging in Lemierre’s syndrome is pivotal, with contrast-enhanced CT of the neck serving as the gold standard for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the routine administration of antibiotics, the intricate anatomy of the deep neck spaces can conceal the full scope of an infection. Therefore, when there is a significant infection involving the internal jugular veins (IJVs), a concurrent evaluation of the carotid arteries is advisable to exclude the possibility of the infection spreading to these vessels [ 66 ]. A thorough understanding of neck anatomy enables radiologists to swiftly trace the likely pathways of infection dissemination.…”

Section: Methodsmentioning

confidence: 99%

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Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Lavalle,

Masiello,

Cocuzza

et al. 2024

Pediatric Reports

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Background: Lemierre syndrome is a rare, potentially fatal complication of oropharyngeal infections characterized by septic thrombophlebitis of the internal jugular vein. It primarily affects healthy adolescents and young adults. Its incidence declined after the antibiotic era, but it may have resurged in recent decades, likely due to judicious antibiotic use and increasing bacterial resistance. Prompt diagnosis and treatment are imperative to prevent significant morbidity and mortality. Methods: Lemierre syndrome has been called “the forgotten disease,” with a reported incidence of around 3.6 cases per million. The mean age at presentation is around 20 years old, though it can occur at any age. Lemierre Syndrome follows an oropharyngeal infection, most commonly pharyngitis, leading to septic thrombophlebitis of the internal jugular vein. F. necrophorum is the classic pathogen, though other organisms are being increasingly isolated. Metastatic infections, especially pulmonary, are common complications. Contrast-enhanced CT of the neck confirming internal jugular vein thrombosis is the gold standard for diagnosis. Long-course broad-spectrum IV antibiotics covering anaerobes are the mainstays of the disease’s treatment. Anticoagulation may also be considered. Mortality rates are high without treatment, but most patients recover fully with appropriate therapy. Conclusions: Lemierre syndrome should be suspected in patients with prolonged pharyngitis followed by unilateral neck swelling and fevers. Early diagnosis and prompt antibiotic therapy are key, given the potential for disastrous outcomes if untreated. An increased awareness of Lemierre syndrome facilitates its timely management.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Lavalle,

Masiello,

Cocuzza

et al. 2024

Pediatric Reports

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“…The computed tomography has gained widespread use as the imaging modality of choice for deep infections of the neck space in the emergency setting, as it overcomes the field of view limitations of ultrasound evaluation, consuming less time and being more accessible than magnetic resonance imaging 31 . However, Christensen et al 32 , analyzed the unnecessary use of computed tomography in patients, establishing two important criteria, which must be identifiable through physical examination, when applying this imaging modality: loss of palpable limits of the mandible body and trismus.…”

Section: Discussionmentioning

confidence: 99%

Maxillofacial infections of dental origin

Fornari,

Souza,

Dallepiane

et al. 2024

Braz.j. of oral sci.

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Aim: to evaluate the occurrence of maxillofacial infection cases, which were treated at local hospital, identifying the main risk factors that determine the need for hospitalization of patients and the factors associated with staying length. Methods: A retrospective review of 191 records of patients with maxillofacial infection of odontogenic origin was performed, statistically evaluated by frequency and percentage of involvement, p values (based on the chi-square test) and odds ratio with a 95% confidence interval. A p-value <0.05 was considered statistically significant. Results: Among all the 191 patients, 31 had some harmful habits, such as smokers (13%) and alcoholics (1%). In addition, 39 patients reported some general health problem, such as systemic arterial hypertension (8.3%), depression (6.8%), diabetes (3.6%) and some immunosuppression (1.57%). Involvement of infection in deep facial spaces was present, with 119 patients presenting a deeper infection (62.3%) and 72 patients a superficial infection (37.7%). The most prevalent clinical signs and symptoms in the initial evaluation were pain (91.1%) and edema (90.1%), followed by erythema/hyperemia (44.5%), trismus (37.7%), abscess (30.9%), cellulitis (27.7%), f istula (16.8%), fever (16.8%), dysphagia (11%), dehydration (9.9%), odynophagia (7.9% ) and dyspnea (3.7%). Pulp necrosis was considered a risk factor for treatment in a hospital environment (0.032) and root canal treatment decreases the risk of hospitalization (p=0.002). Considering the evaluated patients, 146 (76.4%) were admitted and 45 (37.7%) were not admitted for hospitalization after initial clinical evaluation. Conclusion: there is a high occurrence of maxillofacial infection cases of dental origin, considering that involvement of infection in deeper facial spaces, as well as presence of pain, edema, erythema/hyperemia, trismus, abscess, cellulitis and pulp necrosis, represent the main risk factors for hospitalization and staying length.

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“…Thus, these CT parameters were included in the study. Generally, a magnetic resonance scan is utilized as a secondary radiological tool to detect intracranial or spinal complications for DNIs [18].…”

Section: Discussionmentioning

confidence: 99%

“…Imaging is fundamental to confirm the diagnosis of DNIs, and a CT scan is the most utilized tool. A CT scan can determine the source of infection, identify the extent of DNI invasion, and provide early recognition of complications [18]. As parameters for the model in this study, the maximum diameter of the abscess in the axial, coronal, and sagittal planes was measured in a CT scan.…”

Section: Introductionmentioning

confidence: 99%

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

Chen,

Chin,

Chan

et al. 2023

Diagnostics

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Background: Deep neck infection (DNI) is a serious infectious disease, and descending mediastinitis is a fatal infection of the mediastinum. However, no study has applied artificial intelligence to assess progression to descending mediastinitis in DNI patients. Thus, we developed a model to assess the possible progression of DNI to descending mediastinitis. Methods: Between August 2017 and December 2022, 380 patients with DNI were enrolled; 75% of patients (n = 285) were assigned to the training group for validation, whereas the remaining 25% (n = 95) were assigned to the test group to determine the accuracy. The patients’ clinical and computed tomography (CT) parameters were analyzed via the k-nearest neighbor method. The predicted and actual progression of DNI patients to descending mediastinitis were compared. Results: In the training and test groups, there was no statistical significance (all p > 0.05) noted at clinical variables (age, gender, chief complaint period, white blood cells, C-reactive protein, diabetes mellitus, and blood sugar), deep neck space (parapharyngeal, submandibular, retropharyngeal, and multiple spaces involved, ≥3), tracheostomy performance, imaging parameters (maximum diameter of abscess and nearest distance from abscess to level of sternum notch), or progression to mediastinitis. The model had a predictive accuracy of 82.11% (78/95 patients), with sensitivity and specificity of 41.67% and 87.95%, respectively. Conclusions: Our model can assess the progression of DNI to descending mediastinitis depending on clinical and imaging parameters. It can be used to identify DNI patients who will benefit from prompt treatment.

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Imaging assessment of deep neck spaces infections: an anatomical approach

Cited by 4 publications

References 36 publications

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Pediatric Lemierre’s Syndrome: A Comprehensive Literature Review

Maxillofacial infections of dental origin

A Machine Learning Approach to Assess Patients with Deep Neck Infection Progression to Descending Mediastinitis: Preliminary Results

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