Neuro_CT_Neck: 25 M, sore throat and neck swelling.

CT NECK WITH CONTRAST:

CLINICAL HISTORY: 25-year-old with sore throat, neck swelling, concern for retropharyngeal abscess.

FINDINGS:

Pharynx/airway and soft tissues: There is marked swelling of the right tonsils and oropharynx, with

foci of air and irregular fluid extending posteriorly into the right paraglottic soft tissues. There is diffuse infiltration of the subcutaneous tissues of the anterior neck, as well as the fat planes from the nasopharynx to the visualized upper mediastinum. Multiple foci of extraluminal air seen tracking with inflammatory changes, as well as tracts of fluid anteriorly, for example anterior to the thyroid cartilage and right lobe of the thyroid, with phlegmonous change seen in the superior mediastinum posterior to the left subclavian artery. The epiglottis is swollen with swelling extending into the right aryepiglottic fold, narrowing of the supraglottic airway without occlusion.

Major salivary glands: Normal.

Thyroid: No intrinsic abnormality.

Lymph nodes: Prominent bilateral cervical lymph nodes, likely reactive.

Vessels: Diffuse inflammatory changes seen of both carotid sheaths, no evidence of jugular vein thrombosis. Cervical vessels are widely

patent.

Bones: Normal.

Lung apices: There is a cystic lesion in the left upper lobe with a focal area of mural thickening.

Visualized brain parenchyma: Normal.

Additional comment: None.

IMPRESSION:

1. Findings compatible with severe transspatial cervical infection with mediastinal extension with foci of extraluminal air concerning for necrotizing fasciitis/mediastinitis. Origin may be the right oropharynx, with fluid and phlegmonous changes extending in the retropharyngeal tissues, anterior cervical spaces, and visualized upper mediastinum. Epiglottic and supraglottic swelling with narrowing of the supraglottic airway. Inferior extent of disease is incompletely imaged, thoracic imaging may be obtained pre or postoperatively.

2. Cystic lesion in the left lung apex, with focal mural nodularity, likely chronic and unrelated to current active infection, however could represent septic embolization. This can also be evaluated on thoracic imaging as suggested above.

(Necrotizing fasciitis and mediastinitis)

Accession: CL27388626

Study description: CT NECK WITH CONTRAST