Emergency Head and Neck Radiology: Neck Infections

Jason A. McKellop, MD; Suresh K. Mukherji, MD, FACR

Disclosures

Appl Radiol. 2010;39(7):23-29. 

In This Article

Other Pathologies

Foreign Body Ingestion

Among other complications, inadvertent swallowing of foreign objects may result in retropharyngeal space infections, most notably, retropharyngeal abscess formation. Nearly 80% of all swallowed pharyngeal and esophageal foreign bodies take place in the pediatric population.[15] However, adult patients who are stuporous, senile, or have psychiatric illness, are prone to swallowing a variety of foreign objects including animal bones and dentures. These objects are usually lodged in areas of normal anatomic narrowing in the cricopharyngeus area, the aortic arch or the distal esophagus. Sharp objects may perforate the pharynx or esophagus and migrate along tissue planes and compartments. This may result in abscess formation in the adjacent spaces such as the retropharyngeal space.

Children present clinically with respiratory distress, drooling or regurgitation but adults usually present with pain and dysphagia. Senile, psychiatric or stuporous patients may present late with evidence of fever or sepsis.

Non-contrast CT of the neck may be performed to confirm the presence or absence of an ingested foreign body. Contrast-enhanced CT will demonstrate the site and level of the resultant inflammation or abscess. Frequently, gas translucencies are detected within the retropharyngeal space. MR imaging is seldom used for foreign body ingestion as it cannot define reliably the presence of foreign body or gas collections.

Calcific Tendinitis

Calcific tendinitis is a benign inflammatory condition caused by deposition of hydroxyapatite in the tendon fibers of the longus colli muscles.[16] Patients present clinically with either sudden onset or subacute pain in the neck and throat worsened by head movement and swallowing.[17] Due to its rare occurrence, it is often mistaken, clinically, for traumatic injury, retropharyngeal abscess, or infectious spondylitis, causing patients to frequently undergo unnecessary tests and treatment. The condition, however, is self-limited and resolves after 1 to 2 weeks upon calcium resorption.

Lateral neck radiography may show extensive soft-tissue swelling between C1 through C4 with amorphous calcific deposits anterior to C1 and C2.[18] Likewise, CT will demonstrate the same findings along with prevertebral edema – a finding that must be distinguished from that found within retropharyngeal space infection (Figure 13).

Figure 13.

Calcific tendinitis. Axial contrast-enhanced CT of the neck demonstrates retropharyngeal space edema (large arrows). Note the preservation of the alar fascia (small arrows), which indicates that the low attenuation is edema and not an abscess. The bone algorithm shows an ossific mass anterior to the dens, confirming that the edema in the retropharyngeal space is due to calcific tendinitis.

Though typically unnecessary for diagnosis, MRI will demonstrate a signal void anterior to C1 and C2 representing an amorphous calcification. Additionally, MR may demonstrate marrow edema in adjacent vertebrae.

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