Maroldi Roberto, Farina Davide, Ravanelli Marco, Lombardi Davide, Nicolai Piero
Department of Radiology, University of Brescia, Brescia, Italy.
Semin Ultrasound CT MR. 2012 Oct;33(5):432-42. doi: 10.1053/j.sult.2012.06.008.
Deep neck space infection may lead to severe and potentially life-threatening complications, such as airway obstruction, mediastinitis, septic embolization, dural sinus thrombosis, and intracranial abscess. The clinical presentation is widely variable, and often early symptoms do not reflect the disease severity. The complication risk depends on the extent and anatomical site: diseases that transgress fascial boundaries and spread along vertically oriented spaces (parapharyngeal, retropharyngeal, and paravertebral space) have a higher risk of complications and require a more aggressive treatment compared with those confined within a nonvertically oriented space (peritonsillar, sublingual, submandibular, parotid, and masticator space). Imaging has 5 crucial roles: (1) confirm the suspected clinical diagnosis, (2) define the precise extent of the disease, (3) identify complications, (4) distinguish between drainable abscesses and cellulitis, and (5) monitor deep neck space infection progression. Ultrasonography is the gold standard to differentiate abscesses from cellulitis, for the diagnosis of lymphadenitis. and to identify internal jugular thrombophlebitis in the infrahyoid neck. However, field-of-view limitation and poor anatomical information confine the use of ultrasonography to the evaluation of superficial lesions and to image-guided aspiration or drainage. Computed tomography (CT) combines fast image acquisition and precise anatomical information without field-of-view limitations. For these reasons, it is the most reliable technique for the evaluation of deep and multicompartment lesions and for the identification of mediastinal and intracranial complications. Contrast agent administration enhances the capability to differentiate fluid collections from cellulitis and allows the detection of vascular complications. Magnetic resonance imaging is more time-consuming than CT, limiting its use to selected indications. It is the technique of choice for assessing the epidural space involvement in pre- and paravertebral space infections and complements CT in the evaluation of the infections reaching the skull base.
颈部深部间隙感染可能导致严重且潜在危及生命的并发症，如气道梗阻、纵隔炎、脓毒性栓塞、硬脑膜窦血栓形成和颅内脓肿。临床表现差异很大，早期症状往往不能反映疾病的严重程度。并发症风险取决于病变范围和解剖部位：与局限于非垂直方向间隙（扁桃体周围、舌下、颌下、腮腺和咀嚼肌间隙）的疾病相比，跨越筋膜边界并沿垂直方向间隙（咽旁、咽后和椎旁间隙）扩散的疾病并发症风险更高，需要更积极的治疗。影像学检查有5个关键作用：（1）确认疑似临床诊断；（2）明确疾病的精确范围；（3）识别并发症；（4）区分可引流脓肿和蜂窝织炎；（5）监测颈部深部间隙感染的进展。超声检查是区分脓肿与蜂窝织炎、诊断淋巴结炎以及识别舌骨下颈部颈内静脉血栓性静脉炎的金标准。然而，视野限制和解剖信息不足限制了超声检查仅用于评估浅表病变以及图像引导下的抽吸或引流。计算机断层扫描（CT）结合了快速图像采集和精确的解剖信息，且无视野限制。因此，它是评估深部和多间隙病变以及识别纵隔和颅内并发症最可靠的技术。使用对比剂可增强区分液体积聚与蜂窝织炎的能力，并能检测血管并发症。磁共振成像比CT耗时更长，限制了其仅用于特定适应证。它是评估椎前和椎旁间隙感染累及硬膜外间隙的首选技术，在评估累及颅底的感染方面可补充CT检查。
