Accuracy and usefulness of radiographic assessment of cervical neck infections in children.

OBJECTIVE

To determine the accuracy and usefulness of computed tomography (CT) in diagnosis and management of lateral and deep neck infections

METHODS

An 11-year retrospective review of 110 children (age range 1 months to 17 years) was conducted at a tertiary care children's hospital.

RESULTS

Fifteen patients treated medically (8 with cellulitis, 7 with early abscess) improved. Of the remaining 95 patients who had 107 cervical sites drained surgically, CT predicted accurately operative findings in 81 (76%) cases (72 with abscess, 9 with cellulitis). In the 26 (24%) cases with discrepancy between CT interpretation and operative findings, the most common problem was differentiating early abscess from cellulitis with 18 false positives (no abscess at surgery). In 8 cases, CT diagnosis other than abscess was made (4 cellulitis, 1 inflammatory mass, 1 hematoma, 1 lymphangioma, and 1 tumour); however, when the patients were operated on because of lack of improvement, an abscess was found.

CONCLUSIONS

Although CT is helpful both in determining the presence and location of neck infections in children, the CT scan is less helpful in differentiating abscess from lymphadenitis, cellulitis, and some complex cervical masses.