Prediction of deep neck abscesses by contrast‐enhanced computerized tomography in 76 clinically suspect consecutive patients

Freling, Nicole; Roele, Elise D.; Schaefer-Prokop, Cornelia; Fokkens, Wytske J.

doi:10.1002/lary.20606

Cited by 61 publications

(62 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is instrumental in distinguishing cellulitis from abscess, demarcation of anatomic structures surrounding the abscess, identification of airway deviation or obstruction, involvement of the carotid sheath or major blood vessels, and any descending mediastinitis [1]. A fluid collection with peripheral ring enhancement or abnormal air collections could be suggestive of the presence of a deep neck abscess [18]. Moreover, irregularity of the abscess wall (scalloping) was found to be a stronger predictor of the presence of pus than the presence of ring enhancement [19].…”

Section: Discussionmentioning

confidence: 99%

Head and neck cancers manifested as deep neck infection

Lin

Hsu

Lee

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

The incidence of head and neck cancers in patients with an initial presentation of deep neck infection is unclear and may be underestimated. Thus, the aim of this study was to assess the incidence of head and neck cancers initially manifested as deep neck infection. Also, the possible risk factors and pathophysiology are discussed. This study was a retrospective medical chart review in a tertiary referral center. A total of 81 consecutive patients admitted with a diagnosis of deep neck infection over a 46-month period were analyzed. The demographic data, physical examinations, laboratory findings, radiographic studies, and pathology report were analyzed. Among the 81 deep neck infection patients, head and neck cancers were histologically demonstrated in four patients (4.9%) with the initial symptom of a painful neck mass. The incidence of head and neck cancer initially manifested as deep neck infection was found to increase in patients aged over 40 years (6.7%; 3/45 vs. 2.8%; 1/36). A detailed history of all patients with deep neck infection should be taken. Furthermore, endoscopic examination, thyroid examination and routine pathological examination should be performed, especially in those aged over 40. Also, careful explanation to the patient and his/her family about the possibility of underlying head and neck cancer (incidence 1-5%) may be needed. If the neck swelling diminishes, but does not disappear completely after full course of antibiotics, repeated fine needle aspiration, endoscopy, or image study should be considered.

show abstract

Section: Discussionmentioning

confidence: 99%

Head and neck cancers manifested as deep neck infection

Lin

Hsu

Lee

et al. 2011

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

show abstract

“…As such, every patient in our center was assessed either with a contrast enhanced CT scan or by invasive intervention. Contrast enhanced CT scans are useful for diagnosis and identification of the spaces of infection for surgical drainage [15,16]. Although MRI scans may be better for diagnostic purposes [17], they are more difficult to perform in practice, as they require good patient compliance and are also more costly.…”

Section: Discussionmentioning

confidence: 99%

Deep neck abscesses: the Singapore experience

Lee

Kanagalingam

2010

Eur Arch Otorhinolaryngol

View full text Add to dashboard Cite

This study aims to review our experience with deep neck abscesses, identify key trends, and improve the management of this condition. This is a retrospective chart review of patients diagnosed with deep neck abscesses in the Department of ENT (Otorhinolaryngology) at Tan Tock Seng Hospital, Singapore between 2004 and 2009. Patient demographics, etiology, bacteriology, systemic disease, radiology, treatment, complications, duration of hospitalization, and outcomes were reviewed. 131 patients were included (64.9% male, 35.1% female) with a median age of 51.0 years. 54 (41.2%) patients had diabetes mellitus. The parapharyngeal space (23.7%) was the most commonly involved space. Odontogenic and upper airway infections were the leading causes of deep neck abscesses (28.0% each). Klebsiella pneumoniae (27.1%) was the most commonly cultured organism in this study and among the diabetic patients (50.0%). 108 (82.4%) patients underwent surgical drainage. 42 patients suffered complications. All 19 patients, who had upper airway obstruction, had either a tracheostomy or intubation. Patients with multi-space abscesses, diabetes mellitus, and complications had prolonged hospitalizations. Old age and diabetes are risk factors for developing deep neck abscesses and their sequelae. The empiric choice of antibiotics should recognize that a dental source is likely, and that Klebsiella is most common in diabetics. Surgical drainage and adequate antibiotic coverage remains the cornerstone of treatment of deep neck abscesses. Therapeutic needle aspiration may successfully replace surgical drainage, if the abscesses are small and no complications are imminent. Airway obstruction should be anticipated in multi-space and floor of mouth abscesses.

show abstract

“…Described abnormalities are the presence of fluid-like opacities, gas collections, rim enhancement (Freling [10]), soft-tissue swelling, obliterated fat planes, mass effect (Vural [11]), and a scalloping form (Kirse [6]). However, several studies pointed out the poor correlation between CT scan abnormalities and pus finding during surgery [12].…”

Section: Imagingmentioning

confidence: 99%