Neck abscesses are difficult to diagnose and treat. Currently, contrast-enhanced computed tomography (CECT) is the imaging modality of choice. The study aims to determine the predictive value of CECT findings in diagnosing neck abscess, causes of neck abscess and the most common neck space involved in the local population. 84 consecutive patients clinically suspected to have neck abscess who underwent CECT and surgical confirmation of pus were included. Demographic and clinical data were recorded. 75 patients were diagnosed as having neck abscess on CECT; out of those 71 patients were found to have pus. Overall CECT findings were found to have a high sensitivity (98.6%) and positive predictive value (PPV) (94.7%) but lower specificity (67.2%) in diagnosing neck abscess. The CECT diagnostic criterion with the highest PPV is the presence of rim irregularity (96%). The most common deep neck space involved is the submandibular compartment, which correlates with the finding that odontogenic cause was the most common identifiable cause of abscess in the study population. Thus, in a patient clinically suspected of having neck abscess, CECT findings of a hypodense mass with rim irregularity are helpful in confirming the diagnosis and guiding clinical management. 1. Introduction Neck abscesses are still commonly encountered in the era of widespread antibiotic usage. Neck abscesses are usually sequelae of upper respiratory tract infection, odontogenic infection, or even direct trauma [1–5]. These abscesses may spread into adjacent compartments of the neck or into the mediastinum via the retropharyngeal, parapharyngeal, carotid, or prevertebral spaces [1, 2]. The potentially life-threatening complications associated with neck abscess include respiratory embarrassment, mediastinitis, internal jugular vein thrombosis, pseudoaneurysm, fulminant sepsis, and even death. Therefore, neck abscess poses significant morbidity and mortality risks such that any patient suspected to have it should be assessed and treated immediately [1, 3, 6, 7]. However, it is recognized that neck abscesses are difficult to diagnose and treat. Currently, contrast-enhanced computed tomography (CECT) of the neck is the imaging modality of choice in determining the presence of neck abscess and the neck spaces involved. In clinical routine, the examination of the neck should be extended to include the evaluation of the mediastinum in order to exclude the presence of a descending necrotizing mediastinitis as one of the complications aforementioned. The classical radiological description of an
References
[1]
A. L. Weber and A. Siciliano, “CT and MR imaging evaluation of neck infections with clinical correlations,” Radiologic Clinics of North America, vol. 38, no. 5, pp. 941–968, 2000.
[2]
M. Scaglione, M. G. Pezzullo, A. Pinto, G. Sica, G. Bocchini, and A. Rotondo, “Usefulness of multidetector row computed tomography in the assessment of the pathways of spreading of neck infections to the mediastinum,” Seminars in Ultrasound, CT and MRI, vol. 30, no. 3, pp. 221–230, 2009.
[3]
O. O. Daramola, C. E. Flanagan, R. H. Maisel, and R. M. Odland, “Diagnosis and treatment of deep neck space abscesses,” Otolaryngology-Head and Neck Surgery, vol. 141, no. 1, pp. 123–130, 2009.
[4]
G. Marioni, R. Rinaldi, C. Staffieri et al., “Deep neck infection with dental origin: analysis of 85 consecutive cases (2000–2006),” Acta Oto-Laryngologica, vol. 128, no. 2, pp. 201–206, 2008.
[5]
K. Ungkanont, R. F. Yellon, J. L. Weissman, M. L. Casselbrant, H. Gonzáalez-Valdepena, and C. D. Bluestone, “Head and neck space infections in infants and children,” Otolaryngology: Head and Neck Surgery, vol. 112, no. 3, pp. 375–382, 1995.
[6]
J. Stalfors, A. Adielsson, A. Ebenfelt, G. Nethander, and T. Westin, “Deep neck space infections remain a surgical challenge. A study of 72 patients,” Acta Oto-Laryngologica, vol. 124, no. 10, pp. 1191–1196, 2004.
[7]
A. Nubiato Crespo, C. Takahiro Chone, A. Santana Fonseca, M. C. Montenegro, R. Pereira, and J. Altemani Milani, “Clinical versus computed tomography evaluation in the diagnosis and management of deep neck infection,” Sao Paulo Medical Journal, vol. 122, no. 6, pp. 259–263, 2004.
[8]
L. M. Elden, K. M. Grundfast, and G. Vezina, “Accuracy and usefulness of radiographic assessment of cervical neck infections in children,” Journal of Otolaryngology, vol. 30, no. 2, pp. 82–89, 2001.
[9]
N. Freling, E. Roele, C. Schaefer-Prokop, and W. Fokkens, “Prediction of deep neck abscesses by contrast-enhanced computerized tomography in 76 clinically suspect consecutive patients,” Laryngoscope, vol. 119, no. 9, pp. 1745–1752, 2009.
[10]
C. Vural, A. Gungor, and S. Comerci, “Accuracy of computerized tomography in deep neck infections in the pediatric population,” The American Journal of Otolaryngology—Head and Neck Medicine and Surgery, vol. 24, no. 3, pp. 143–148, 2003.
[11]
D. J. Kirse and D. W. Roberson, “Surgical management of retropharyngeal space infections in children,” Laryngoscope, vol. 111, no. 8, pp. 1413–1422, 2001.
[12]
J. B. Lazor, M. J. Cunningham, R. D. Eavey, and A. L. Weber, “Comparison of computed tomography and surgical findings in deep neck infections,” Otolaryngology—Head and Neck Surgery, vol. 111, no. 6, pp. 746–750, 1994.
[13]
M. Nagy, M. Pizzuto, J. Backstrom, and L. Brodsky, “Deep neck infections in children: a new approach to diagnosis and treatment,” Laryngoscope, vol. 107, no. 12 I, pp. 1627–1634, 1997.
[14]
P. Boscolo-Rizzo, C. Marchiori, F. Zanetti, A. Vaglia, and M. C. da Mosto, “Conservative management of deep neck abscesses in adults:the importance of CECT findings,” Otolaryngology—Head and Neck Surgery, vol. 135, no. 6, pp. 894–899, 2006.
[15]
F. W. Craig and J. E. Schunk, “Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management,” Pediatrics, vol. 111, no. 6, pp. 1394–1398, 2003.
[16]
J. E. McClay, A. D. Murray, and T. Booth, “Intravenous antibiotic therapy for deep neck abscesses defined by computed tomography,” Archives of Otolaryngology-Head and Neck Surgery, vol. 129, no. 11, pp. 1207–1212, 2003.
[17]
R. F. Wetmore, S. Mahboubi, and S. K. Soyupak, “Computed tomography in the evaluation of pediatric neck infections,” Otolaryngology—Head and Neck Surgery, vol. 119, no. 6, pp. 624–627, 1998.
[18]
“We’ve highest diabetes rate in the region,” News Straits Times, 2012.
[19]
Y. Q. Lee and J. Kanagalingam, “Deep neck abscesses: the singapore experience,” European Archives of Oto-Rhino-Laryngology, vol. 268, no. 4, pp. 609–614, 2011.
[20]
A. Mazita, M. Y. S. Hazim, M. A. R. Megat Shiraz, and S. H. A. Primuharsa Putra, “Neck abscess: five year retrospective review of Hospital University Kebangsaan Malaysia experience,” Medical Journal of Malaysia, vol. 61, no. 2, pp. 151–156, 2006.
[21]
W. D. Miller, I. M. Furst, G. K. B. Sàndor, and M. A. Keller, “A prospective, blinded comparison of clinical examination and computed tomography in deep neck infections,” Laryngoscope, vol. 109, no. 11, pp. 1873–1879, 1999.
[22]
J. L. Smith II, J. M. Hsu, and J. Chang, “Predicting deep neck space abscess using computed tomography,” American Journal of Otolaryngology: Head and Neck Medicine and Surgery, vol. 27, no. 4, pp. 244–247, 2006.
