Deep neck infections of congenital causes.

OBJECTIVES: To review cases of deep neck infections with underlying congenital etiology with special emphasis on their clinical presentations and the computed tomographic findings and to discuss the various therapeutic modalities employed for such lesions. STUDY DESIGN: Case series with chart review. SETTINGS: Alexandria University Hospital, Egypt. SUBJECTS AND METHODS: The authors retrospectively reviewed the clinical, imaging, and operative records of deep neck infection cases presented to their department in the past 10 years. Deep neck infection cases due to congenital causes were included in the study. RESULTS Of the 249 cases of deep neck infections admitted to the authors' department in the past 10 years, 39 patients were diagnosed with deep neck infections due to congenital causes. Patients were classified into 2 groups. In group 1 (29 patients), computed tomography revealed the presence of infected cystic swelling in the neck that was classified as second branchial cyst (16 patients), third and fourth branchial cysts (8 patients), and thyroglossal cyst (5 patients). Group 2 (10 patients) presented with recurrent attacks of deep neck infection with a history of incision and drainage several times. Radiological and operative findings revealed the presence of congenital pyriform fossa sinus. CONCLUSION: Computed tomography is helpful in diagnosing infected congenital cysts and its types. Infected congenital cysts could be excised completely under an umbrella of antibiotics. Recurrence of deep neck infections should alert the physician to the possibility of underlying congenital lesions. Thorough clinical and radiological assessment is mandatory to rule out the possibility of a congenital pyriform fossa sinus.

Thyroid imaging in a typical case of acute suppurative thyroiditis with abscess formation due to infection from a persistent thyroglossal duct.

The clinical evaluation of thyroid imaging with 99mTc, 201Tl, and 67Ga in the uncommon, but potentially serious, disorder of acute suppurative thyroiditis (AST) with abscess formation due to infection from a persistent thyroglossal duct is reported. The 99mTc image showed functioning areas of the diseased thyroid gland and the 201Tl image demonstrated abscess formation in the thyroid gland of this patient. In addition, marked 67Ga accumulation was demonstrated in a wide area covering not only the area of the thyroid gland involved, but also associated circumferential inflammatory lesions in a patient with AST. The net thyroid uptake of 67Ga at 72 hours was calculated to be 13.8% of the injected dose.

Head and neck manifestations of mycobacteria in the absence of pulmonary disease.

Mycobacterial infections, once relatively rare in North America have recently shown an upsurge with the influx of Asian and African immigrants. The infections are usually due to M. tuberculosis and present with pulmonary symptoms. However, an uncommon presentation is that of a mass in the head and neck region without any pulmonary manifestations. Although these infections are usually secondary to invasion by "atypical" mycobacteria, unusual presentations due to mycobacterium tuberculosis have been noted. Case reports depicting the very rare presentations of M. tuberculosis in the thyroglossal duct cyst, parotid, and submandibular lymph node are described. A very unusual case of atypical mycobacteria in the larynx is noted and cervical adenitis is also included. The initial subtle presentation emphasizes the importance of mycobacteria in the differential diagnosis of lesions in the head and neck region.