Recurrence of a deep neck infection: a clinical indication of an underlying congenital lesion.

OBJECTIVE: To discuss the computed tomographic (CT) and clinical findings of those entities that may present as recurrent deep neck infections. PATIENTS AND METHODS: Twelve patients with recurrent deep neck infections and CT scans were retrospectively identified since 1990. Their CT scans and medical histories were reviewed. The diagnosis was pathologically confirmed in all cases. RESULTS: The CT scans revealed an abscess or a localized infected cyst in the deep soft tissues of the neck, with varying degrees of associated inflammatory change in the adjacent soft tissues. The diagnoses in these cases included 1 first branchial cleft cyst, 3 second branchial cleft cysts, 1 third branchial cleft cyst, 2 fourth branchial cleft cysts, 2 infected lymphangiomas, 2 thyroglossal duct cysts, and 1 cervical thymic cyst. CONCLUSIONS: Most deep neck infections are the result of suppurative adenitis. The location of the primary focus is usually from the mucosa of the upper aerodigestive tract or from an odontogenic source. Less common causes are perforations due to a foreign body, thrombophlebitis of the internal jugular vein, or osteomyelitis of the spine. Recurrences in these situations are unusual. Less commonly, congenital lesions can present as deep neck infections, and recurrences are common. Our cases suggest that the recurrence of a deep neck infection should alert the physician to the possibility of an underlying congenital lesion and that CT is helpful in the early recognition of these lesions.

CT of pilomatrixoma in the cheek.

Pilomatrixoma is an uncommon benign tumor arising from hair follicles. They occur most commonly in the head and neck region, and are usually found in girls during the first two decades of life. These tumors may contain calcification, which, when present, is helpful in suggesting the diagnosis. We present a classic case of pilomatrixoma in the cheek of a young woman. The tumor was documented on CT studies, which showed a subcutaneous, noninvasive mass with calcifications.

Subcutaneous fat necrosis of the newborn: CT findings of head and neck involvement.

We present the CT findings in two newborns with subcutaneous fat necrosis. This is an uncommon disease that occurs in neonates who have had difficult deliveries. The CT findings varied from discrete subcutaneous nodules to a diffuse subcutaneous fullness. Although the subcutaneous disease tends to spontaneously resolve within weeks to months, an associated hypercalcemia may have a fatal outcome.

Retropharyngeal mass as a rare presentation of a goiter: CT findings.

When sufficiently large, goiters often extend into the mediastinum. Less often, there is extension into the tracheoesophageal groove and the retroesophageal space, and, rarely, there may be growth into the retropharyngeal space. In the latter instance the goiter will present clinically as an oropharyngeal mass in a patient with stridor. We report two similar cases documented with CT studies that clearly show that the origin of the retropharyngeal mass was the thyroid gland.

Sternocleidomastoid tumor of infancy: CT manifestations.

A case of sternocleidomastoid tumor of infancy in a 1-month-old boy is presented. Fine-needle aspiration biopsy can be used to confirm the diagnosis and thereby avoid more invasive procedures. Early diagnosis and treatment are important factors in achieving a good clinical outcome.

Lingual osteoma.

The 29th patient with a lingual osteoma is presented. This is the first case, to our knowledge, with preoperative radiographic and computed tomographic documentation. This rare, benign tumor almost always occurs as a pedunculated solitary mass that arises from the posterior tongue near the foramen cecum. The patients are usually young women who complain wf dysphagia or fullness in the base of the tongue. The imaging findings and theories of the origin of this tumor are described.

Multicentric parotid cysts and cervical adenopathy in AIDS patients. A newly recognized entity: CT and MR manifestations.

Patients with AIDS or ARC may present with parotid gland enlargement either initially or during the course of their disease. Of nine such patients, eight had unilateral gland enlargement, and one had bilateral disease. CT and MR scanning revealed that all patients except one had bilateral multiple intraparotid cysts. In addition, four of the nine patients clinically had cervical adenopathy, while all patients had adenopathy on scanning. We believe that the association of parotid cysts and cervical adenopathy is another manifestation of AIDS or ARC and, when found on scanning, should alert the clinician to the probable underlying condition.

The use of magnetic resonance and computed tomography in the management of a patient with intrasinus hemorrhage.

The judicious use of computed tomography and magnetic resonance imaging in a critically ill patient with leukemia is discussed to demonstrate how a rapid and accurate diagnosis of intrasinus hemorrhage was established, thereby avoiding an unnecessary invasive procedure in this high-risk patient. In this clinical setting, a brief T1-weighted study distinguished between blood and infection.

Benign and malignant parotid pleomorphic adenomas: CT and MR studies.

Parotid pleomorphic adenomas are usually benign, solitary, ovoid masses. Occasionally, these tumors may be highly lobulated and clinically mimic multiple lesions. Actual multiple benign mixed tumors are rare as are malignancies that occur in these pleomorphic adenomas. Of these malignancies, the most common type is the carcinoma ex pleomorphic adenoma. Two patients are presented, one of whom had a markedly lobulated benign mixed tumor and the other patient had an ex pleomorphic malignancy associated with multiple benign mixed tumors. Both cases are documented with CT and magnetic resonance studies. The relative merits of these modalities are discussed as they apply to these parotid masses.

Metastatic hypernephroma to the head and neck.

Eight cases of metastatic hypernephroma to the head and neck are presented with CT documentation. Hypernephroma is the third most common infraclavicular tumor to metastasize to the head and neck. Such metastases occur in about 15% of patients with this neoplasm, and nearly 8% of patients with this tumor present with disease in the head and neck region. These metastases are usually vascular and may either clinically precede the diagnosis of the renal primary tumor or may occur many years after apparently successful surgery of the primary tumor. These unusual patterns of behavior are reviewed. One of the cases presented here is the first reported incidence of cervical lymph node metastasis with hemorrhage to be documented by CT, thus adding this entity to the list of imaging differential diagnoses of cystic-appearing neck masses.

Persistent cervical adenitis and nasopharyngeal carcinoma in children.

The high prevalence of inflammatory disease in pediatric patients makes the occurrence of prominent adenoidal tissue and cervical adenopathy a common finding. Unfortunately, rare nasopharyngeal cancer shares these physical findings in common with benign inflammatory disease of the pharynx. Computed tomography permits evaluation of nodal necrosis or wall nodularity, allowing clinically silent submucosal tumor extension to be well defined. In patients with suspected nasopharyngeal inflammatory disease who do not respond to conservative therapy, computed tomography can be used to aid directed biopsies.

Intramuscular head and neck myxoma: report of a case and review of the literature.

Intramuscular myxoma of the head and neck is a rare lesion with only six cases documented in the literature. The tumor demonstrates a benign clinical course without a tendency to recur and is occasionally associated with fibrous dysplasia. It thus deserves to be considered in a separate class from other soft tissue myxomas. The seventh case of a head and neck intramuscular myxoma is presented and the clinical, pathological, and CT characteristics of this tumor are reviewed.

Intraosseous petrous apex neuroma: CT findings.

An avascular, contrast enhancing intraosseous petrous apex mass was discovered on CT in a patient with prior colonic carcinoma and acute myelocytic leukemia. A normal bone scan made metastasis unlikely and surgery revealed a neuroma. The differential diagnosis is discussed.

Kissing intrasellar carotid arteries in acromegaly: CT demonstration.

Acromegaly is a disease with protean manifestations that are well described in the literature. One finding infrequently encountered is aneurysmal dilatation of the internal carotid arteries and their branches. A case is presented, with CT documentation, in which the enlarged cavernous portions of the internal carotid arteries prolapsed into the sella turcica and enlarged it. Frontal bossing, frontal sinus enlargement, a dense cortical calvarium, prominent inion, and proptosis secondary to extraocular muscular enlargement were findings also present in this patient. The sella CT appearance has brought the term "kissing intrasellar arteries" to mind to suggest the diagnosis.

Internal jugular vein phlebectasia and duplication: CT features.

Phlebectasia of the internal jugular vein (IJV) is a rare entity with only 25 cases having been reported. Clinically this condition presents with enlargement with a Valsalva maneuver and decrease at rest. Venography, anteriography, and ultrasound have previously been used to diagnose this unusual cause of neck mass. We present a case in which CT confirmed the clinical diagnosis and in which there was an incomplete ipsilateral duplication of the IJV. This is only the second case reported of IJV phlebectasia and duplication.

Two benign CT presentations of thyroid-related papillary adenocarcinoma.

Two cases of thyroid-related papillary adenocarcinoma are presented. Both patients had clinically benign neck masses that were clearly separated from the thyroid gland. In both cases the thyroid gland was normal to clinical evaluation, CT, and 99mTc scanning. One patient had an occult thyroid carcinoma with a solitary metastatic node in the lateral neck, and the other patient had a rare carcinoma in a suprahyoid thyroglossal duct cyst that had been previously misdiagnosed as a cystic hygroma.

Auricular reconstruction with postauricular myocutaneous flap.

In the past reconstruction of large auricular defects more than 2 cm have been repaired with the use of local skin flaps from various sites in multiple stages. This entails longer hospitalization and a poorer aesthetic result. We developed a postauricular myocutaneous flap that has been used successfully in five patients. The cosmetic results are superior to previously described reconstructive techniques. This flap, which can be used in immediate one-stage reconstruction, is based on the auricular branch of the posterior auricular artery. This vessel supplies the auricularis posterior muscle, the skin over the mastoid, and the cranial surface of the auricle. This vessel was dissected and found to be anatomically consistent in five cadavers.

Computed tomography of glomus tympanicum tumors.

Previously it has been very difficult or impossible for radiologists to delineate accurately the size and extent of glomus tympanicum tumors. By utilizing axial transverse and coronal computed tomography detailed enlargement techniques we have been able to accurately demonstrate four such lesions. We believe that this mode of investigation is now the method of choice for glomus tympanicum tumors.

Unrecognized aspiration of an oropharyngeal airway.

A case of unsuspected aspiration of an oropharyngeal airway causing dysphagia is described. Visualization of this airway on plain film would be facilitated if radio-opaque material were included at manufacture.

Maxillary sinusitis as a cause of cheek swelling. A rare occurrence.

Inflammatory swelling of the cheek is an extremely rare complication of antral sinusitis. When such swelling occurs, diagnostic search for a specific coexisting condition must be made. The differential diagnosis includes a postsurgical or posttraumatic defect in the anterior antral wall; an unusual fungal, granulomatous, or neoplastic disease of the maxillary sinus; dental infection; or dacryocystitis.