Carroll William, Van Beck Jenna, Roby Brianne
ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA; University of Minnesota, Department of Otolaryngology, Minneapolis, MN, USA.
ENT and Facial Plastic Surgery, Children's Minnesota, Minneapolis, MN, USA; University of Minnesota, Department of Otolaryngology, Minneapolis, MN, USA.
Int J Pediatr Otorhinolaryngol. 2019 Oct;125:56-58. doi: 10.1016/j.ijporl.2019.06.023. Epub 2019 Jun 26.
Pediatric deep neck space infections (DNSI) may cause internal jugular vein and/or carotid artery narrowing. Radiologists and otolaryngologists are often queried by emergency room providers and pediatricians with regards to the clinical significance when this radiographic finding is noted. There are often questions raised about need for further imaging, anticoagulation and overall management strategy. There is limited data to support our answers to these questions. This study investigated the clinical significance of vessel narrowing of the internal jugular vein and carotid artery in the setting of DNSI in children.
208 patients over a 10 year period were reviewed in retrospective fashion. CT scans reports were evaluated for vessel narrowing, and clinical outcomes were analyzed.
This study found that nearly half (44.7%, 93 of 208) of pediatric DNSIs reviewed showed evidence of either carotid and/or internal jugular vein narrowing. There was no significant difference in vascular complications in those with vessel narrowing and those without (p = 0.09). There were no observed neurologic complications in either group.
Vessel narrowing is a very common finding in pediatric DNSI. Vascular complications are very rare, and importantly no patients had neurologic complications in either group (vessel narrowing or not). We found no evidence to support more aggressive surgical management, getting further imaging, starting anticoagulation, nor changing overall management strategy for patients based solely to the finding of vessel narrowing in DNSI.
小儿深部颈部间隙感染(DNSI)可能导致颈内静脉和/或颈动脉狭窄。当发现这种影像学表现时,急诊室医护人员和儿科医生经常会向放射科医生和耳鼻喉科医生询问其临床意义。对于是否需要进一步成像、抗凝以及整体管理策略,常常会有疑问。支持我们回答这些问题的数据有限。本研究调查了小儿DNSI情况下颈内静脉和颈动脉血管狭窄的临床意义。
对10年间的208例患者进行回顾性研究。评估CT扫描报告中的血管狭窄情况,并分析临床结果。
本研究发现,所回顾的小儿DNSI中近一半(44.7%,208例中的93例)显示有颈动脉和/或颈内静脉狭窄的证据。有血管狭窄和无血管狭窄的患者在血管并发症方面无显著差异(p = 0.09)。两组均未观察到神经并发症。
血管狭窄在小儿DNSI中是非常常见的表现。血管并发症非常罕见,重要的是两组(有或无血管狭窄)均无患者出现神经并发症。我们没有发现证据支持仅基于DNSI中血管狭窄的发现而对患者采取更积极的手术治疗、进一步成像、开始抗凝或改变整体管理策略。