Abstract
BackgroundDeep neck infections are showing resurgence in the current era and still pose threatening diagnosis. CT is the gold standard imaging modality; still, the reported low sensitivity and specificity was suggested in view of monophasic injection technique.The purpose of the study was to discuss the diagnostic accuracy of CT with biphasic mode of injection using and a single scanning phase. The first 50–60 cc of IV contrast are injected at a slow rate of 1 cc/s to (tissue impregnation phase). The other 50–60 cc was injected at a high rate of 2 cc/sec, approximately 1 min after the first injection. The single phase of scanning is made followed by multi-planar image analysis of collection. Discrimination of abscess versus phlegmon is made according to described criteria.ResultsRadiological diagnosis was made of 64/66 cases of abscess and two cases only had phlegmon. The 64 cases of abscess underwent drainage by ENT surgeon showing correctly diagnosed drainable abscess in 59 out of 64 cases and 5 falsely diagnosed as abscess proved to be non-drainable phlegmon. The two patients with radiological diagnosis of non-drainable phlegmons were correctly diagnosed.ConclusionThe study achieved a high accuracy of 92%. This is likely attributed to dual-phase technique that allows enhancement of the core of a phlegmon by slow interstitial phase, while combined dual injections allow enhancing the “rim enhancement sign” of abscess.
Highlights
Deep neck infections are showing resurgence in the current era and still pose threatening diagnosis
The extent of deep space involvement is difficult to be accurately made by clinical evaluation, with accurate localization of infection could be made in only 42.9% of cases in one series and in another series, the extent of deep neck space infection was under-estimated in up to 70% of cases [7, 8]
The radiologists must be familiar with the anatomy of the deep cervical fascia and the spaces bounded by these fascial planes; this is because the layers of the deep cervical fascial are not readily well seen on contrast-enhanced Computed tomography (CT) [9]
Summary
Deep neck infections are showing resurgence in the current era and still pose threatening diagnosis. Deep neck space infection (DNI) means infection in the potential spaces and fascial planes of the neck, either with abscess formation, phlegmon or cellulitis, or a combination of any of them [1]. Computed tomography (CT) scans of the head and neck is a critical component in the evaluation of the extent of deep neck infection because physical examination alone can misidentify the involved space and the number of involved spaces in 70% of cases. CT scans with intravenous contrast provide good visualization of most bony and soft tissue structures and fascial spaces of the head and neck. The intravenous contrast allows visualization of the great neck vessels and enhancement of areas of inflammation and allows identification of collections and evaluation of suspect complications [10]
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