What is the role of CT scanning in the workup of deep neck infections?

Updated: Apr 30, 2020
  • Author: Alan D Murray, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

CT scanning

  • CT scans with contrast are the gold standard in evaluation of deep neck infections. The importance of CT scanning is highlighted in a study by Crespo et al, who found that clinical examination alone underestimated the extent of deep neck space infections in 70% of patients. CT scans indicate the location, boundaries, and relation of infection to surrounding neurovascular structures. Abscesses are seen as low-density lesions with rim enhancement, occasional air fluid levels, and loculations (see the images below). A study by Kirse and Roberson also notes the association between irregularity of the abscess wall on CT as predictive of pus within the cavity. [22] CT scans are fast, relatively inexpensive, and fairly widely available today. CT scanning of the chest may be helpful if extension into the mediastinum is suspected.

    CT scan of the neck demonstrating left peritonsill CT scan of the neck demonstrating left peritonsillar abscess.
    Right lateral pharyngeal (parapharyngeal) abscess Right lateral pharyngeal (parapharyngeal) abscess as seen on CT scan. Note the medial extension in the retropharyngeal area.
    Same patient as in the previous image. Lower cut C Same patient as in the previous image. Lower cut CT scan showing the abscess cavity. The rim enhancement and partial loculation are well demonstrated.
  • A prospective, blinded study of the effectiveness of CT scanning in diagnosing deep neck infections in adults over the age of 18 showed that CT scan with contrast is 95% sensitive and 53% specific for distinguishing a drainable fluid collection. When CT findings were combined with clinical exam findings, the sensitivity remained about 95%, but the specificity increased to about 80%. The data regarding the utility of CT scans in diagnosing deep neck infections in children are not as clear as in adults.


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