Cervical lymph nodes are located in the sides and back of the neck. Note the thickening of the left platysma muscle (arrow). Figure 23b. The adult cases that do occur usually are due to foreign body perforation (26). Retropharyngeal edema due to calcific tendinitis of the longus colli in a 71-year-old woman. The lymph nodes beneath and surrounding the thyroid gland, breathing tube (trachea) and swallowing tube (esophagus) that run in between the carotid arteries and extend in the area beneath the breast bones are called the central compartment lymph nodes. Groups of lymph nodes are found in the neck, around the collarbone, in the armpit (axilla), and in the groin. With this disease, autoantibodies stimulate the thyroid-stimulating hormone receptors on follicular cells, in effect mimicking thyroid-stimulating hormone. The vocal cords should be evaluated for signs of asymmetry, as paralysis may occur owing to compression of the recurrent laryngeal nerve (40). Note the tapered superior and inferior margins in b. Cervical lymph nodes are located in the sides and back of the neck. 62, No. A PTA is an accumulation of pus in the loose tissue around the palatine tonsil. When a branchial cleft anomaly is not infected, it appears at CT as a fluid-attenuation cyst with a thin wall (12). Progression of intraorbital infection can result in thrombosis of the superior ophthalmic vein, which can then propagate to the cavernous sinus. Fungal sinus disease includes allergic fungal sinusitis and invasive fungal sinusitis. Axial 0.625-mm images constructed by using bone and soft-tissue kernels also are sent to the picture archiving and communication system. 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). Use caution when giving aspirin to children or teenagers. Acute unilateral sialadenitis most commonly involves the parotid gland and is usually caused by an ascending bacterial infection from the oral cavity in the setting of salivary stasis and dehydration (25). Cancer Imaging. 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). In some people, pneumatized spaces extend to the apical (medial) portion of the temporal bone and are termed petrous apex air cells. Neck pain along the lymph nodes can be caused by enlargement of the lymph nodes (lymphadenopathy) or inflammation of the lymph nodes (lymphadenitis). Subcutaneous edema (white arrowheads) also is present. In contrast, carotidynia is a poorly understood idiopathic condition characterized by neck pain and focal tenderness in the region of the carotid bifurcation. If there has been a perforation, extraluminal gas and fluid may be present. Noting an anterior mediastinal mass in a patient with cervical adenopathy can help the clinician diagnose lymphoma. The axillary lymph nodes or armpit lymph nodes are lymph nodes in the human armpit. In the acute phase, the lymph nodes are enlarged and homogeneously enhance at CT. As caseation occurs, the nodes become centrally hypoattenuating and cystic, with perinodal fat stranding that is milder than what is seen with bacterial adenitis (Fig 15). The CT diagnosis is dependent on the identification of abnormal calcific attenuation, which is usually seen within the longus colli tendon, inferior to the anterior arch of C1. The oral cavity (black * in b) is obliterated. Axial nonenhanced CT image shows an enlarged thyroid gland (black *) surrounding the trachea (arrow), which is narrowed to 8 × 5 mm. These vessels travel proximally, draining through several lymph nodes . At CT, these nodes are enlarged, rounder than the normally elongated cervical nodes, and centrally necrotic. There is associated subcutaneous edema (white arrowheads) of the face and edema in the left orbit. (a) Sagittal contrast-enhanced CT image in a 41-year-old man shows a normal epiglottis (arrow) measuring 2–3 mm in thickness. Otitis externa, also called swimmer’s ear, is a superficial infection of the external auditory canal (EAC) that is related to minor trauma or liquid exposure such as that from swimming. Other causes of goiter include Graves disease and toxic or nontoxic nodular goiter. These glands are usually very small. Numerous common and clinically significant pathologic conditions may be seen in the lung apices at neck CT. Bony breakthrough occurs at weak points of the alveolar process, which include the buccal surface throughout the maxilla and the lingual surface in the area of the mandibular molars. (a, b) Axial (a) and sagittal (b) nonenhanced CT images show retropharyngeal edema (arrowheads). The thyroid gland synthesizes the hormones triiodothyronine and thyroxine. Figure 7. Planes and motions (diagrams) Whole head. References Grégoire V, Ang K, Budach W, Grau C, Hamoir M, Langendijk JA, Lee A, Le QT, Maingon P, Nutting C, O'Sullivan B, Porceddu SV, Lengele B. Delineation of the neck node levels for head and neck tumors: a 2013 update. Knowledge of this complex anatomy is necessary when a mass or inflammatory process is identified, and a strategy for determining which structures are deviated and the direction of the deviations must be used to make a diagnosis or differential diagnosis. The vertebral arteries course along the posterior neck, passing through the transverse foramina of the C2–C6 vertebrae. (2014) Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology. As an exception, contrast material is not required to identify a suspected retained aerodigestive tract foreign body (5). (a) Axial contrast-enhanced CT image shows foci of gas and fluid (white arrows) in the left submandibular space, with extension to the danger space (black arrows). While dedicated CT angiography is generally superior for the specific evaluation of arterial disease, many arterial abnormalities can be identified on standard soft-tissue neck CT images. (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). Lymph nodes are round, bean-shaped glands, and you have them throughout your body. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. ). Select a zone . If there is tracheal compression, the craniocaudal length of the compression and the degree of reduction of the cross-sectional area should be estimated. Robbins KT, Clayman G, Levine PA, Medina J, Sessions R, Shaha A, Som P, Wolf GT. Nodules or masses are frequently encountered on CT images, and the detection of them in the lung apices at neck CT can be helpful for the analysis of other examination findings. 2000;174 (3): 837-44. Figure 19a. Ninety percent of cases of viral sialadenitis involve the parotid glands, while 10% also involve the submandibular glands (44). 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. Figure 10a. (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. Iodine deficiency is an important cause of goiter worldwide, but it is uncommon in the United States. The presence of metastases in the lung apices can aid in characterizing nonspecific neck CT findings as likely neoplastic rather than infectious or inflammatory. However, a few points should be made to differentiate malignant adenopathy from infectious adenopathy. Spinal Tumors and Pseudotumors . Note the thickening of the left platysma muscle (arrow). Tumors and pseudotumors in the cervical spine appear as hard lumps near the neck midline. 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. (a) Sagittal contrast-enhanced CT image in a 41-year-old man shows a normal epiglottis (arrow) measuring 2–3 mm in thickness. Updated definition of level VI lymph node classification in the neck. The condition involving mastoid effusion in conjunction with septal erosion is referred to as coalescent mastoiditis (60). Main symptoms … 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). Figure 25a. Figure 14a. In comparison, the right parotid gland (black arrowhead) is normal. (a, b) Acute right submandibular sialadenitis in a 57-year-old woman. (c) Coronal contrast-enhanced CT image at the level of the parotid glands in a 22-year-old woman with acute left parotiditis shows edema, enlargement, and hyperenhancement of the left parotid gland (white arrowhead). Infection may spread into the periodontal or more distant tissues as a result of dental procedures such as tooth extraction (33). 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). Robbins KT, Shaha AR, Medina JE, Califano JA, Wolf GT, Ferlito A, Som PM, Day TA. However, in the setting of neck pain, degenerative disease may be relevant with regard to the symptoms reported by the patient. Residual thymic tissue should not be confused for disease, particularly in children and young adults (71). (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. 2. Therefore, neck CT may be performed to rule out treatable diagnoses. With few exceptions, neck CT should be performed with intravenous contrast material, which accentuates abnormally enhancing phlegmonous and neoplastic tissues and can be used to delineate any abscesses or necrotic areas. Additional similar lesions were seen on other images (not shown). MRI is useful for evaluating intracranial extension of mastoiditis. Sometimes a lymph node, or group of nodes, may appear larger than they should on a scan, such as an ultrasound scan, CT scan or MRI scan. Retrospective correlation of CT scans and surgical findings in 51 patients with laryngeal cancer undergoing radical neck dissection suggested that the node-bearing areas in the neck can be usefully evaluated with CT scans. ), Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210 St, Bronx, NT 10467; Department of Radiology, Westchester Medical Center, Valhalla, NY (W.A.G. This defect leads to the formation of a false lumen, which is frequently accompanied by narrowing or occlusion of the true lumen (51). When it is infected, the wall thickens and demonstrates contrast enhancement, and surrounding inflammatory fat stranding develops (12). The major salivary glands include the parotid, submandibular, and sublingual glands. In this condition, CT may demonstrate irregularity and erosion of the articular bone, fluid in and around the joint, and/or infiltration of adjacent paraspinal fat planes. Epidural abscess and subgaleal phlegmon in a 13-year-old boy. (a) Axial contrast-enhanced CT image shows a left retropharyngeal low-attenuation lymph node (arrow), consistent with internal suppuration. 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). There is usually bilateral involvement, which may lead to airway obstruction at the level of the oral cavity and oropharynx (4). Figure 10b. Malignant otitis externa is a life-threatening disease that is typically seen in elderly patients with diabetes, and it is caused by Pseudomonas aeruginosa infection in more than 90% of cases (8). (2007) Acta oto-laryngologica. Accessory parotid tissue often can be seen along the course of its duct (Stensen duct) superficial to the masseter muscle. Left petrous apicitis in an 11-year-old girl who presented with ear drainage and diplopia. Periodontal disease—that is, inflammation of the gingiva (gums)—can progress to periodontitis, in which the periodontal ligament that connects the tooth to the alveolar process, as well as the bone of the alveolar process, is lost (Fig E8). Figure 24b. Figure 22. Associated imaging abnormalities may include mural thickening of the affected carotid artery and stranding of surrounding fat (Fig 16) (52). The primary infection—for example, tonsillitis—is included in the “Aerodigestive Tract” section. Seventy-five percent of the time, scrofula is unilateral. Forty-four percent of adults and 50% of children have imaging findings of sinusitis, although they undergo imaging for other reasons (56). 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. Additional images (not shown) did not show a stone within or along the course of the parotid duct. Although acute conditions are the first that come to mind, malignancy must remain in the differential diagnosis. We spoke with head and neck surgeon Stephen Lai, M.D., Ph.D., to learn more. Therefore, for the diagnosis of acute sinusitis, supporting clinical signs and symptoms such as fever and pain overlying the affected sinuses must be present. 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). 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