Berman J, Myssiorek D, Reppucci A, Zito J
Department of Otolaryngology & Communicative Disorders, Long Island Jewish Medical Center, New Hyde Park, NY 11042.
Ear Nose Throat J. 1991 Jun;70(6):393-5.
It is a clinical challenge to distinguish patients with parotid abscesses from those with acute sialadenitis. A case of parotid abscess is presented in which a CT scan with intravenous contrast enhancement localized the abscess cavity and guided its aspiration and drainage with an indwelling catheter. By using this percutaneous technique, the need for early surgical intervention by incision and drainage was eliminated. The dense overlying parotid fascia and position of the deep parotid lobe make differentiating between these two clinical entities difficult. Parotid abscesses are readily apparent on computerized tomographic (CT) scanning evaluation with intravenous contrast enhancement, presenting as discrete fluid-filled areas unlike the amorphous appearance of acute sialadenitis. CT scanning with intravenous contrast enhancement has been the preferred radiographic study of choice for evaluating parotid masses or parapharyngeal masses. The treatment of a patient with acute sialadenitis differs from that of a patient with a parotid abscess. Patients with acute sialadenitis will usually respond to vigorous intravenous (IV) hydration, use of sialagogues and appropriate antibiotic coverage. Following a period of conservative treatment with antibiotics and warm soaks, patients with parotid abscesses will usually undergo an incision and drainage procedure, and later, parotidectomy. A case of parotid abscess is presented in which a CT scan with intravenous contrast enhancement localized the abscess cavity and guided its aspiration and drainage with an indwelling catheter. Percutaneous drainage of parapharyngeal abscesses guided by CT has been previously described by Cole. By using this percutaneous technique, the need for early surgical intervention by incision and drainage was eliminated.
区分腮腺脓肿患者和急性涎腺炎患者是一项临床挑战。本文介绍了一例腮腺脓肿病例，通过静脉注射造影剂增强的CT扫描定位脓肿腔，并通过留置导管引导脓肿抽吸和引流。通过使用这种经皮技术，消除了早期通过切开引流进行手术干预的必要性。腮腺上方致密的筋膜和腮腺深叶的位置使得区分这两种临床实体变得困难。在静脉注射造影剂增强的计算机断层扫描（CT）评估中，腮腺脓肿很容易显现，表现为离散的液性区域，与急性涎腺炎的无定形外观不同。静脉注射造影剂增强的CT扫描一直是评估腮腺肿块或咽旁肿块的首选影像学检查。急性涎腺炎患者的治疗与腮腺脓肿患者不同。急性涎腺炎患者通常对积极的静脉补液、使用催涎剂和适当的抗生素治疗有反应。经过一段时间的抗生素保守治疗和热敷后，腮腺脓肿患者通常会接受切开引流手术，随后进行腮腺切除术。本文介绍了一例腮腺脓肿病例，通过静脉注射造影剂增强的CT扫描定位脓肿腔，并通过留置导管引导脓肿抽吸和引流。Cole之前曾描述过在CT引导下经皮引流咽旁脓肿。通过使用这种经皮技术，消除了早期通过切开引流进行手术干预的必要性。
