The goals in CT scanning of the neck are to allow sufficient time after contrast administration for mucosa, lymph nodes, and pathologic tissue to enhance, yet acquire images while the vasculature remains opacified. Lung lymph nodes are located in the bronchi, while the tracheobronchial and paratracheal groups are in the neck area. The abscess or phlegmon most commonly develops superior to the palatine tonsil, between the capsule of the tonsil (which lies medial to the abscess) and the superior pharyngeal constrictor muscle (which lies peripheral to the abscess) (21). Epidural abscess and subgaleal phlegmon in a 13-year-old boy. Valves, which are visible in the internal jugular veins occasionally, and heterogeneous enhancement due to the mixing of opacified and nonopacified blood should not be mistaken for thrombosis. If you feel lumps accompanied by tenderness, you may have swollen lymph nodes. The reader is referred to the relatively recent article regarding orbital emergencies published in this journal (65). CT is 100% sensitive and 75% specific for detection of PTA, which on CT images most commonly appears as a rim-enhancing collection superolateral to the palatine tonsil (Fig 4) (21). Sinusitis may be acute or chronic and have an allergy-related, viral, bacterial, or fungal cause. I have the same problem a raised hard lymph node on the left hand side of my neck and also other Lymph nodes that are raised. In fact, about 20-30% of “node-negative” patients have disease present in their lymph nodes even though CT scans and/or ultrasound studies suggest that the lymph nodes are negative or do not contain disease. (a) Axial contrast-enhanced CT image shows a left retropharyngeal low-attenuation lymph node (arrow), consistent with internal suppuration. 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. From a practical standpoint, this entails examination of the nasal cavity and nasopharynx, oral cavity and oropharynx, hypopharynx, larynx, and imaged portions of the trachea and esophagus. Internal cysts and a calcification also are noted. Pneumonia appears as nodular and/or consolidative opacities in the lung parenchyma. During a physical examination, a doctor may feel (palpate) these areas to look for swollen or enlarged lymph glands. Noting an anterior mediastinal mass in a patient with cervical adenopathy can help the clinician diagnose lymphoma. Figure 24b. Lymph nodes that lie near the surface of the skin, such as in the neck, armpit, groin, and sometimes those in the arm (elbow) and back of the knee may be felt when enlarged, but others may only be seen on imaging studies such as a CT scan. Mycobacterial cervical lymphadenitis, referred to as scrofula, may be tuberculous or nontuberculous (47). Lemierre syndrome in a 15-year-old girl. Note the thickening of the left platysma muscle (arrow). Male cadaver. When reporting dental lesions, the amount of detail should be tailored to the given clinical setting. Infection may spread into the periodontal or more distant tissues as a result of dental procedures such as tooth extraction (33). Infectious involvement of the epidural space may occur in isolation or within the context of vertebral infection. (a) Axial nonenhanced CT image (bone window) shows an opacified left frontal sinus, with thinning of the posterior wall of the sinus (arrowhead). ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. On a typical neck CT image, a substantial portion of the inferior frontal and temporal lobes, along with the brainstem, posterior fossa, and suprasellar cistern, which includes the circle of Willis, is visible. If the dental disease is directly related to the reason that the examination was performed, a complete discussion is warranted. Nodal metastases usually lack the surrounding inflammatory stranding that is seen with bacterial adenitis. Factors that predispose individuals to having nodular goiter include iodine deficiency and genetics; the exact causal mechanism is uncertain. Retropharyngeal abscess must be differentiated from retropharyngeal edema, which may be an accessory finding due to other infectious processes or represent inflammation such as that due to prior radiation therapy or calcific tendinitis of the longus colli. Swollen lymph nodes tell you that something is not right, but other symptoms help pinpoint the problem. Evaluating these structures in a systematic manner, from the superior to inferior aspect, ensures that all findings will be identified. At CT, acute bacterial sinusitis is characterized by the presence of fluid and mucosal thickening in one or more sinuses (55). Groups of lymph nodes are found in the neck, around the collarbone, in the armpit (axilla), and in the groin. Axial contrast-enhanced CT image shows a homogeneously enlarged thyroid gland (*). 2. CT atlas of thoracic lymph node stations as defined by IASLC, with ambiguous regions designated as per El-Sherief et al. Because there are components of the respiratory, digestive, vascular, endocrine, skeletal, and neurologic systems in the neck, the radiologist is required to have knowledge and an understanding of how disease manifests and how an abnormality in one system can spread and affect other systems. The submandibular and sublingual glands have higher attenuation than does the parotid gland owing to their lower fat content. (2014) Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. Do we need a change in ED diagnostic strategy for adult acute epiglottitis? Forty-four percent of adults and 50% of children have imaging findings of sinusitis, although they undergo imaging for other reasons (56). Axial (a) and coronal (b) contrast-enhanced CT images show bilateral low-attenuation collections (arrows) superolateral to the palatine tonsils (* in b). Lymph nodes affected by lymphoma usually have a rubbery consistency. They are basically one subgroup of the two cervical lymph nodes which are the major lymph nodes of the head. There is also thickening of the left platysma muscle (arrow). A peritonsillar abscess (PTA) or peritonsillar phlegmon develops following tonsillitis or pharyngitis and is the most common pediatric head and neck abscess (20). The degree of reduction of the right parotid gland is isoattenuating to muscle orbits. Readily evaluated at standard contrast-enhanced neck CT findings of bacterial discitis and osteomyelitis loss... 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