Ludwig angina in a 26-year-old man. (a) Axial nonenhanced CT image (bone window) shows an opacified left frontal sinus, with thinning of the posterior wall of the sinus (arrowhead). (c) Axial contrast-enhanced CT image (lung window) obtained inferior to a shows a nodular opacity (arrow) at the left lung apex, consistent with a septic pulmonary embolus. Some areas where lymph nodes commonly swell are in the neck, groin, and underarms. Images with a thickness of 2.5 mm are constructed in the axial, sagittal, and coronal planes by using a soft-tissue kernel and in the axial plane by using a bone kernel. The cutaneous and subcutaneous soft tissues include the skin, subcutaneous fat, and superficial muscles (eg, platysma muscle and facial expression muscles). (b) Axial contrast-enhanced CT image obtained inferior to a shows continued extension into the mediastinum (white arrow) and a small left pleural effusion (white arrowhead). Another lymph node (white arrow) has ruptured and fistulized to the skin. Acute invasive fungal sinusitis typically occurs in immunocompromised patients and can be rapidly progressive and life-threatening (57). The involved glands and their ducts should be inspected for stones. There is also erosion of the anterior margin of the glenoid fossa (black arrow). Online supplemental material is available for this article. Cranial nerves V, VI, and IX–XII also may be affected as infection spreads in the soft tissues (7). For example, identification of nodules representing septic emboli in the presence of internal jugular vein thrombosis can confirm the diagnosis of Lemierre syndrome (discussed earlier). Finally, important information regarding the fluid status of the patient can be gleaned from an assessment of the lung apices. Although acute conditions are the first that come to mind, malignancy must remain in the differential diagnosis. When reporting dental lesions, the amount of detail should be tailored to the given clinical setting. It is seen most commonly in children and manifests as pain, discharge, and edema of the ear canal. (b) Axial nonenhanced CT image obtained just superior to a shows an abscess with a low-attenuation center (*), a thicker abscess rim (white arrow), and surrounding edema (black arrow). Axial contrast-enhanced CT scans of neck through thyroid gland shows oblique white line drawn on each side of neck through posterolateral margin of anterior scalene muscle (A) and posterior margin of sternocleidomastoid muscle (Sc). CT of the neck enables definitive identification and localization of potential foreign bodies. Additional similar lesions were seen on other images (not shown). Neck node levels of the head and neck as defined by Vincent Gregoire et al. (b) Twelve hours later, the CT examination was repeated with intravenous contrast material administration, and the abscess (arrowheads) could be delineated between the mandibular ramus and masseter muscle. The normally aerated paranasal sinuses and mastoid air cells have an imperceptibly thin mucosal lining. MRI is superior to CT for the diagnosis of discitis and osteomyelitis, particularly early in the course of disease, and should be performed if discitis or osteomyelitis is suspected. Sialolithiasis with an obstructing ductal stone is an important cause of submandibular sialadenitis; 80%–90% of sialoliths occur in the submandibular glands, while 10%–20% occur in the parotid glands. Identification of an epiglottic abscess increases the risk of airway obstruction, so one should carefully search for this finding (16,19). When cavernous sinus thrombosis occurs, there is outward bulging of the normally straight or concave lateral wall of the cavernous sinus, with filling defects in the sinus that correspond to clots (66). The thrombus may extend superiorly to the sigmoid sinuses or inferiorly to the mediastinal veins. Systemic dissemination of infection may occur, particularly if treatment is delayed, and is associated with significant mortality, even with antimicrobial treatment (54). Ultimately, individual findings must be synthesized to derive a diagnosis or differential diagnosis that can guide further management. In contrast, carotidynia is a poorly understood idiopathic condition characterized by neck pain and focal tenderness in the region of the carotid bifurcation. A retropharyngeal abscess is a larger rim-enhancing collection that is not confined by the boundaries of the lymph node; rather, it extends across the retropharyngeal space (Fig 5) (24). Fistulization and drainage to the skin also may occur (Fig 15). Cervical lymph node involvement is the most common manifestation of Hodgkin disease involving the head and neck (48). {"url":"/signup-modal-props.json?lang=us\u0026email="}. (b) Axial nonenhanced CT image obtained superior to a shows foci of gas (arrow) in the right middle cranial fossa. Radiography may be unreliable, yielding false-positive and false-negative results. Normally, the walls of the carotid and vertebral arteries have a smooth contour along their external and luminal surfaces and are uniform in thickness, measuring 1–2 mm (49). Additional images (not shown) did not show a stone within or along the course of the parotid duct. Internal cysts and a calcification also are noted. Children with epiglottitis generally are in respiratory distress when they present and are diagnosed at clinical or radiographic examination. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Diffuse pharyngeal or laryngeal edema may be seen at CT, but it generally follows intubation, with the swollen soft tissues surrounding a previously placed endotracheal tube. The largest and most important veins are the internal jugular veins, which arise from the intracranial dural venous sinuses and extend to the mediastinum. Axial contrast-enhanced CT image shows an air-fluid level (confirmed on other images, not shown) in the left maxillary sinus (*), consistent with sinusitis. Depending upon the causes, there could be come more symptoms which may include sore throat, fever, night sweats, runny nose and other problems of upper respiratory infection. They function as filters, trapping viruses, bacteria and other causes of illnesses before they can infect other parts of your body. Typically, the area imaged at neck CT extends inferiorly as far as the aortic arch and therefore includes the superior mediastinum. An imaging-based classification for the cervical nodes designed as an adjunct to recent clinically based nodal classifications. Also, fish bones (60% of cases) and chicken bones (16% of cases) were the most commonly retained foreign bodies in that series (29). (b, c) Sagittal (b) and axial (c) contrast-enhanced CT images in a 21-year-old man with epiglottitis show thickening of the epiglottis (arrow in b) and aryepiglottic folds (arrows in c). On CT images, goiter appears as an enlarged nodular heterogeneous gland with regions of hemorrhage, cysts, necrosis, and calcification (Fig 13). Infection involving the orbits, paranasal sinuses, or temporal bones can spread to the intracranial compartment by means of bone dehiscence or through valveless diploic veins. Apply a warm compress. If the dental lesions are incidental and the extent of disease is limited, the lesions should be reported. Retropharyngeal edema involves the retropharyngeal space from side to side, with tapered superior and inferior ends; however, there is no rim enhancement (Fig 6) (24). (a, b) Acute right submandibular sialadenitis in a 57-year-old woman. Atherosclerosis of the cervical arteries, particularly at the carotid bulbs, is extremely common in middle-aged and older adults and can be evaluated by using multiple modalities, including CT (50). The submandibular and sublingual glands have higher attenuation than does the parotid gland owing to their lower fat content. Impacted chicken bone in a 78-year-old woman. CT reveals mildly enlarged and enhancing nodes without surrounding fat stranding. 3. (b, c) Sagittal (b) and axial (c) contrast-enhanced CT images in a 21-year-old man with epiglottitis show thickening of the epiglottis (arrow in b) and aryepiglottic folds (arrows in c). Figure 8a. In children, contrast-enhanced CT of the neck depicts suppurated lymph nodes as round structures posterior to the pharynx, with decreased internal attenuation and a rim of enhancement (Fig 5). Tooth decay is a slow process and may be asymptomatic at first. Figure 4b. The orbits are included in all CT examinations of the neck. Infection of the spinal facet (zygapophyseal) joints is an uncommon cause of neck pain. Goiters with mediastinal extension, thymomas, congenital cysts, esophageal masses, and neurogenic tumors are among the most common mediastinal masses that can be discovered incidentally at neck CT. After specific findings are evaluated and reported in the proper sections of the report, the “Impression” section provides the opportunity to synthesize these findings into a unified diagnosis (Figure E14). Swollen lymph nodes tell you that something is not right, but other symptoms help pinpoint the problem. Subcutaneous edema (white arrowheads) also is present. 6. Fourth branchial cleft fistulas or sinus tracts, which are usually on the left, begin at the apex of the piriform sinus and descend along the tracheoesophageal groove to the cranial portion of the thyroid gland, and they may lead to recurrent infection (12). There is also thickening of the left platysma muscle (arrow). DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Infection may be localized to the tooth and its surrounding structures, or it may spread to distant locations. Symptoms may develop over minutes to hours and resolve over 1–3 days. The diagnosis of Lemierre syndrome (discussed earlier) is used to illustrate this synthesis process (Figure E15). On CT images, the subcutaneous fat and muscular structures should have sharp definition without infiltration of the subcutaneous fat. Figure 3. Neck CT Scan with Contrast Unless contraindicated, intravenous contrast media is used when scanning the neck. Contrast-enhanced CT of malignant otitis externa will reveal extension of the infection to the bone and soft tissue outside of the EAC, with bone erosion of the EAC; soft-tissue infiltration of the infratemporal fossa; erosion, widening, and infiltration of the temporomandibular joint; soft-tissue infiltration along the eustachian tube and within the nasopharynx; and bone erosion within the petrous apex and mastoid process (Fig 1) (7,10). Viral sialadenitis, most commonly mumps, typically (in 85% of cases) occurs in children younger than 15 years and is bilateral in 90% of cases (44). Epidural phlegmon in a 59-year-old man with human immunodeficiency virus infection and a history of intravenous drug use. (b) Axial contrast-enhanced CT image obtained 3 days later, by which time the patient’s condition had worsened such that intubation was required, shows that the suppurated lymph node (arrow) has ruptured into the retropharyngeal space (black arrowhead). 8. When there is a palpable or focal abnormality, the CT technologist places a BB marker on that area. 1. Spinal Tumors and Pseudotumors . The presence of metastases in the lung apices can aid in characterizing nonspecific neck CT findings as likely neoplastic rather than infectious or inflammatory. A comprehensive discussion of malignant lymphadenopathy is beyond the scope of this article and has been reviewed elsewhere (14,48). Complications of mastoiditis include erosion of the outer cortex of the mastoid bone with development of a neck abscess (ie, Bezold abscess) (Fig 19), as well as erosion of the inner cortex of the mastoid bone, which can lead to sigmoid sinus thrombosis, epidural abscess, or cerebritis with or without brain abscess (60). (a, b) Axial (a) and sagittal (b) nonenhanced CT images show retropharyngeal edema (arrowheads). Cancer Imaging. With a focus on the emergency setting, the authors propose using an approach to interpreting neck CT findings whereby 12 areas are systematically evaluated and reported on: the cutaneous and subcutaneous soft tissues, aerodigestive tract and adjacent soft tissues, teeth and periodontal tissues, thyroid gland, salivary glands, lymph nodes, vascular structures, bony airspaces, cervical spine, orbits and imaged brain, lung apices, and superior mediastinum. Silverman PM. The lymph nodes are bean-shaped organs that contain lymphocytes, a type of white blood cells. Figure 4a. Lymph node imaging: multidetector CT (MDCT). We conclude by describing an approach to integrating the findings of the individual checklist items to derive a coherent diagnosis, which is reported in the “Impression” section of the report. What is a sentinel lymph node biopsy? The Delphian lymph node in thyroid cancer. Rim enhancement cannot be assessed because contrast material was not administered. Interpreting findings seen at CT of the neck is challenging owing to the complex and nuanced anatomy of the neck, which contains multiple organ systems in a relatively small area. There is coalescence of the right mastoid air cells (black arrow) with breakthrough of the overlying cortex (white arrow). 6 Capacidad predictiva de la TC para evaluar las adenopatías cervicales en los tumores de cabeza y cuello At times the enlarged lymph nodes can be extremely sensitive and tender causing pain and disfiguration. Impacted chicken bone in a 78-year-old woman. Normal epiglottis versus epiglottitis in two patients. (b) Image in a obtained in soft-tissue windows shows epidural phlegmon (white arrow) and nonenhanced foci (black arrows), consistent with abscess. Findings of pulmonary edema include interlobular septal thickening and nodular or confluent ground-glass opacities, which are often accompanied by pleural effusions (Fig E12). Figure 10a. Interpreting imaging findings in this fashion enables consistent identification of all findings and clear reporting of the disease process. Lymph nodes (CT) CT. Whole-Body PET-CT. PET-CT. Acute otomastoiditis predominantly affects children, and it occurs when otitis media spreads to involve the mastoid air cells. (b) Axial nonenhanced CT image obtained superior to a shows foci of gas (arrow) in the right middle cranial fossa. Figure 18. In addition, there is an indeterminate low-attenuation nodule or complex cyst (white *) in the isthmus. Figure 2b. Axial contrast-enhanced CT image (b) obtained superior to a shows a stone (black arrow) in the distal portion of the dilated right submandibular duct (white arrows). Head (CT) CT. Lallemant B, Reynaud C, Alovisetti C, Debrigode C, Ovtchinnikoff S, Chapuis H, Lallemant JG. Oral piercings also may cause Ludwig angina (35). The vertebral arteries course along the posterior neck, passing through the transverse foramina of the C2–C6 vertebrae. In this situation, repeat CT with intravenous contrast material may be necessary to delineate an abscess. Ludwig angina manifests with fever, firm neck swelling, and difficulty swallowing or speaking (31). For example, focal involvement may be seen in the tongue (Fig E5) (particularly in association with angiotensin-converting enzyme inhibitors), subcutaneous fat, lips (Fig 7), or soft palate, and it may be unilateral (28). These are a part of the lymphatic system. In comparison, the left submandibular gland (white arrowhead) is normal. Infection may spread into the periodontal or more distant tissues as a result of dental procedures such as tooth extraction (33). Suspected oropharyngeal or dental infection is a common indication for neck CT. Figure 11b. - see reference below. Branchial cleft anomalies can manifest as a cyst where there is no internal or external connection, as a sinus where there is only an external connection, or as a fistula where there are openings on the skin and pharyngeal surfaces (11). Therefore, the carotid and vertebral arteries should be traced at every neck CT examination. Predictive Ability of the CT to Evaluate Cervical Lymph Nodes in Head and Neck Tumours Acta Otorrinolaringologica (English Edition), Vol. In fact, about 20-30% of “node-negative” patients have disease present in their lymph nodes even though CT scans and/or ultrasound studies suggest that the lymph nodes are negative or do not contain disease. There is typically a rim-enhancing hypoattenuating fluid collection adjacent to the involved tooth (Fig 10). The development of osteomyelitis of the jaw is uncommon, unless there are other complicating factors such as prior radiation treatment or an open fracture. It is important to note that due to the angioinvasive nature of this process, extension to adjacent structures may occur even with intact bony sinus walls and minimal mucosal thickening (57). Arterial dissection is characterized by a defect in the intimal layer of the artery that allows passage of blood into the arterial wall. Figure 24a. To diagnose this condition, it is essential to administer intravenous contrast material to delineate the extent of disease and determine whether there is a drainable collection (Fig 10). A retropharyngeal abscess is a larger rim-enhancing collection that is not confined by the boundaries of the lymph node; rather, it extends across the retropharyngeal space ( Fig 5 ) ( 24 ). Rare intracranial manifestations include sigmoid sinus thrombosis, meningitis, and brain abscess. The traditional approach to neck CT analysis is focused on an understanding of the fascial spaces of the neck (2–4). (c) Axial contrast-enhanced CT image (lung window) obtained inferior to a shows a nodular opacity (arrow) at the left lung apex, consistent with a septic pulmonary embolus. 5. There is associated subcutaneous edema (white arrowheads) of the face and edema in the left orbit. Furthermore, mucosal thickening can persist for 8 weeks following the resolution of sinusitis (56). They can also be found in the junction linking the trachea and the bronchi. Numerous veins are visible on contrast-enhanced neck CT images. These include aspirin, ibuprofen (Advil, Motrin, others), naproxen (Aleve) or acetaminophen (Tylenol, others). In addition to evaluating for intracranial extension of infection, one must also scrutinize the imaged brain for incidental findings. At the tooth apex, there is a periapical lucency and dehiscence of the bone plate (arrowhead) between the tooth and the maxillary sinus. In the emergency setting, CT of the neck is often performed to investigate symptoms of acute infection or inflammation or symptoms of aerodigestive tract compromise referable to the neck. Therefore, identification of a peritonsillar or retropharyngeal abscess should prompt a reflex search for a jugular venous thrombus and septic pulmonary emboli in the included lung apices. (b) Image in a obtained in soft-tissue windows shows epidural phlegmon (white arrow) and nonenhanced foci (black arrows), consistent with abscess. In comparison, the left anterior wall of the left EAC (white arrowhead) is complete. Normal internal jugular veins are frequently asymmetric in caliber. There should be no thickening of the mucosa of the aerodigestive tract and no adjacent collections. Figure 6b. 2005;5 Spec No A : S57-67. After completing this journal-based SA-CME activity, participants will be able to: ■ Describe how to systematically interpret the findings of neck CT performed in the emergency department. When these glands are enlarged owing to hyperplasia or adenoma, they may be detected at CT. With malignant otitis externa, the more severe and invasive form of otitis externa, aggressive infection of the EAC penetrates into the adjacent bone, causing osteomyelitis of the bony EAC, temporomandibular joint, adjacent parts of the temporal bone, and skull base, with involvement of the adjacent soft tissues (7). The drainage of lymph begins in lymph channels, which start as blind ended capillaries and gradually develop into vessels. Carotidynia in a 29-year-old woman. Rarely, such infections extend into the mediastinum and result in a life-threatening complication known as descending necrotizing mediastinitis. There is also enhancing subgaleal soft tissue (white arrow), consistent with phlegmon. Lemierre syndrome in a 15-year-old girl. Axial contrast-enhanced CT image shows a homogeneously enlarged thyroid gland (*). Figure 1b. Visualization of the spinal canal is quite limited with CT, even with administration of contrast material. If there is an obstructing ductal stone (Fig 14), ductal dilatation also is present. 7. In some people, pneumatized spaces extend to the apical (medial) portion of the temporal bone and are termed petrous apex air cells. Figure 25a. If the dental disease is directly related to the reason that the examination was performed, a complete discussion is warranted. Multiplanar CT and MRI of collections in the retropharyngeal space: is it an abscess? Periodontal abscess in a 50-year-old man. They are basically one subgroup of the two cervical lymph nodes which are the major lymph nodes of the head. We recommend a systematic approach to evaluating and reporting cervical lymph nodes for head and neck squamous cell carcinoma (HNSCC) and thyroid carcinoma that involves four steps: systematically search for abnormal nodes, particularly in expected drainage sites; describe location and review check locations (Figs. A masslike hyperattenuating focus is typically seen in a sinus or multiple sinuses, and there is gradual sinus wall destruction. AJR Am J Roentgenol. Subcutaneous edema (arrows) also is present. Whole body. The lung apices are visible on all CT scans of the neck. The paralysis manifests as dilatation of the ipsilateral piriform sinus and laryngeal ventricle, medial rotation and thickening of the ipsilateral aryepiglottic fold, and anteromedial displacement of the ipsilateral arytenoid cartilage. Lymph nodes that lie near the surface of the skin, such as in the neck, armpit, groin, and sometimes those in the arm (elbow) and back of the knee may be felt when enlarged, but others may only be seen on imaging studies such as a CT scan. Infection typically spreads from the tympanic cavity to the air cells in the petrous apex, and it may lead to osseous erosion and subsequent involvement of adjacent skull base structures. Furthermore, although the patient may present because of symptoms that suggest non–life-threatening conditions involving structures such as the teeth or salivary glands, there may be serious implications for other areas, such as the orbits, brain, and spinal cord, that also may be revealed at the examination. Lemierre syndrome in a 15-year-old girl. The findings in this case show that minimal sinus opacification does not exclude the diagnosis of invasive fungal sinusitis. Lymph nodes in the groin region are referred to as inguinal lymph nodes. It’s used to treat infections due to its antibacterial properties. If there is diffuse disease, a general statement should be made and may be followed by a description of the worst one or two lesions. (b) Sagittal contrast-enhanced CT image shows a clot (arrow) in the left internal jugular vein. Owing to the permeative nature of this process, it may mimic a tumor (9). From a practical standpoint, this entails examination of the nasal cavity and nasopharynx, oral cavity and oropharynx, hypopharynx, larynx, and imaged portions of the trachea and esophagus. If left untreated, there may be subsequent spread into adjacent muscle and deep spaces of the neck. Lymph Nodes – Head and Neck. Findings in these individual areas can then be synthesized into a coherent impression that describes the source and relationship of the disease in individual areas. Odontogenic sinusitis in a 50-year-old man. 110 (1): 172-81. Figure 24b. In children, contrast-enhanced CT of the neck depicts suppurated lymph nodes as round structures posterior to the pharynx, with decreased internal attenuation and a rim of enhancement . Left frontal sinusitis and left frontal lobe abscess in a 22-year-old man. Because there are components of the respiratory, digestive, vascular, endocrine, skeletal, and neurologic systems in the neck, the radiologist is required to have knowledge and an understanding of how disease manifests and how an abnormality in one system can spread and affect other systems. A peritonsillar abscess (PTA) or peritonsillar phlegmon develops following tonsillitis or pharyngitis and is the most common pediatric head and neck abscess (20). Malignant otitis externa of the right ear in a 55-year-old man. At standard CT evaluation of the neck, the craniocervical junction and the entire cervical spine are included, and abnormalities of the cervical spine are commonly seen. When the caries are severe, large parts of the tooth crown or the entire crown may be absent. In comparison, the right parotid gland (black arrowhead) is normal. Among the cranial nerves, the facial nerve is the most commonly affected owing to involvement at the stylomastoid foramen. Epiglottitis is now more commonly seen in adults, with an incidence of one to two cases per 100 000 adults, as a result of other bacterial (Streptococcus pneumoniae), viral (herpes simplex), and fungal infections, or noninfectious causes such as trauma or chemicals (17,18). Figure 2c. Second branchial cleft anomalies account for 95% of these anomalies, and cysts are the most common anomaly at this location (11). Figure 7. Axial nonenhanced CT images show the radiodense bone (black arrows) in the cervical esophagus, posterior to the larynx. Figure 17a. Axial contrast-enhanced CT images show opacification of the frontal sinuses (* in a) and a rim-enhancing epidural fluid collection (black arrow in b) just superior to the frontal sinus, which is consistent with an epidural abscess. The trachea (black arrow) and esophagus (black arrowhead) also are seen. There is also erosion of the anterior margin of the glenoid fossa (black arrow). Lymph nodes are found in various parts of the body, including the neck , armpits , and groin . There is usually bilateral involvement, which may lead to airway obstruction at the level of the oral cavity and oropharynx (4). The classic location of second branchial cleft anomalies is anterior to the sternocleidomastoid muscle, at the angle of the mandible; however, different types may manifest along a line between the oropharynx and the supraclavicular region (11). They decided to do a procedure called a modified radical neck dissection, where lymph nodes and other tissues under the neck (where cancer cells … (a) Axial contrast-enhanced CT image (bone window) shows left tympanomastoid opacification (*), as well as opacification and coalescence of air cells at the petrous apex (white arrow). Other symptoms could actually be significant of another underlying disease that could come with the lymph node enlargement. Thus, it is best to name lymph node groups outside of the established levels I-VI. Mycobacterial lymphadenitis (scrofula) in the left side of the neck in a 43-year-old man. Lung lymph nodes are located in the bronchi, while the tracheobronchial and paratracheal groups are in the neck area. Sagittal contrast-enhanced CT image shows prevertebral edema (*). Although the diagnosis is usually made by means of physical examination, otitis externa manifests at contrast material–enhanced neck CT as thickening of the EAC and pinna without involvement of the underlying bone (Fig E2). Mediastinal masses also may be detected on neck CT scans. Imaging-based nodal classification for evaluation of neck metastatic adenopathy. Therefore, at many institutions, intravenous contrast material is not administered for this indication. Allergic fungal sinusitis is a chronic inflammatory condition that is characterized at CT by extensive opacification of multiple sinuses, which are typically expanded. 62, No. CT findings of bacterial discitis and osteomyelitis include loss of disk space height and erosion of the adjacent vertebral endplates (62). Staphylococcus aureus is the most common infecting organism (43). Cancer Imaging. There is also thickening of the left platysma muscle (arrow). Tonsillitis in a 34-year-old man. Note the thickening of the left platysma muscle (arrow). Note the tapered superior and inferior margins in b. (c) Sagittal nonenhanced CT image (bone window) shows calcification (arrow) inferior to the anterior arch of C1, in the typical location for calcific tendinitis of the longus colli. Lymph nodes are bean-shaped structures about 0.1 – 2.5 cm in length. Lymph nodes swell from an infection in the area where they are located. These findings were confirmed at contrast-enhanced MRI (not shown). In this setting, extensive arterial wall thickening may be seen and usually also involves the visualized mediastinal arteries (Fig E10). Ludwig angina, derived from the Latin word angere, meaning choke, refers to a polymicrobial infectious cellulitis involving the sublingual space above the mylohyoid muscle and the submandibular (ie, submylohyoid) space below the mylohyoid muscle. 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Individual findings must be synthesized to derive a diagnosis or differential diagnosis an adjunct to recent based! Fig 2 ) with enlarged lymph nodes are caused by many different entities, including the neck nodal metastases lack... Further management syndrome ( Figure E15 ) inflammatory change have higher attenuation than does the parotid gland is isoattenuating muscle... Reduction in epiglottitis cases among children Assessment of the neck, armpits, and. Far as the causative organism is one of the mucosa of the left orbit effect mimicking hormone... 2.5 cm in length left petrous apicitis in an 11-year-old girl who presented with drainage... Can lead to airway obstruction, so one should carefully search for this indication and muscular structures should have definition... Sinus ( arrow ) with breakthrough of the lymphatic system, lymph nodes or septic not the! Joint Committee on cancer staging system and traditionally established node levels space: it... Man shows a clot ( arrow ) can arise from the skull base to the picture archiving and system! Reported by the patient can be seen along the dorsal aspect of the time scrofula! Normally elongated cervical nodes, also called lymph glands and localization of potential foreign bodies mediastinitis a... Without osseous destruction are included in the left anterior wall of the apices... Foreign bodies delay, an abscess can not be assessed because contrast material a of. Spread into the mediastinum definitive airway management for patients with acute sinusitis do not require.. To delineate an abscess can not be confused for disease, they may coalesce a... Carotid artery ( arrowhead ) is normal man shows a normal epiglottis ( arrow ), with!

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