Imaging

Neck abscess

Preliminary Diagnosis: Neck abscess

I. What imaging technique is first-line for this diagnosis?

  • CT soft tissue neck with contrast

II. Describe the advantages and disadvantages of this technique for diagnosis of neck abscess.

Advantages

  • Relatively inexpensive and fast imaging modality

  • Able to detail potential etiology for neck abscess (dental caries, foreign body, complicated cellulitis, etc) and can detail any potential secondary complications

  • Particularly helpful in differentiating many of the complex neck anatomical structures such as vessels, lymph nodes, and muscles

Disadvantages

  • Exposure to ionizing radiation

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients

  • Relative contraindication in patients with contrast allergies

  • Relative contraindication for use of contrast in patient with renal failure

IV. What alternative imaging techniques are available?

  • MR imaging with contrast

  • Gray scale and color Doppler ultrasonography

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of neck abscess.

MR imaging with contrast

Advantages

  • Does not make use of ionizing radiation

Disadvantages

  • Expensive

  • Time consuming

  • Requires significant patient cooperation to minimize motion artifact

  • Fine neck anatomy is not as well differentiated with MR imaging

  • Osseous structures are not well identified on MR imaging

Gray scale and color Doppler ultrasonography

Advantages

  • Highly portable and inexpensive.

Disadvantages

  • Well adept to evaluating only superficial lesions

  • Operator dependent

  • Less specific and sensitive than MR and CT in evaluating for neck abscess

VI. What are the contraindications for the alternative imaging techniques?

MR imaging with contrast

  • MR imaging is contraindicated in patients with non–MR-compatible hardware.

  • Relative contraindication for contrast use in patients with renal failure

Gray scale and color Doppler ultrasonography

  • No specific contraindications exist.

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