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CT Neck Parapharyngeal Abscess

TECHNIQUE: Helical CT scanning of the neck from the skull base to the aortic arch were obtained following the intravenous administration of iodinated contrast and reformatted into 2.5 mm axial, sagittal and coronal images.

There is a rim-enhancing right parapharyngeal mass which measures 1.5 x 2.0 x 3.5 cm.
This extends inferiorly adjacent to the hyoid bone and nearly to the level of the thyroid gland.
There is also submucosal involvement, with fluid density lesion at the right piriform sinus which causes airway narrowing at the level of the piriform sinuses.
There is also thickening of the aryepiglottic folds associated with a small amount of fluid density, and thickening at the epiglottis.
The right submandibular gland appears enlarged.
Numerous small lymph nodes are identified in the right anterior and posterior cervical chains, none of which appear necrotic or significantly enlarged by size criteria.
The thyroid gland demonstrates a normal CT appearance.
The vascular structures are patent, and demonstrate normal caliber.
Limited views of the skull base and orbits are normal.
The lung apices are clear.
The cervical spine demonstrates degenerative changes, most pronounced at C5-C6 and C6-C7 with loss of disc height and anterior osteophyte formation.

1. Right parapharyngeal abscess, and submucosal lesion at the level of the right piriform sinus. Submucosal mass is likely related to infection, however, other underlying process cannot be excluded. These findings could also be the result of an infected fourth branchial cleft cyst or an atypical thyroglossal duct cyst. Recommend followup imaging and/or direct visualization for further evaluation, and to exclude underlying lesion.
2. Epiglottitis.
Findings: The previously noted right neck abscess and supraglottic soft tissue swelling has resolved. Nodular opacities in the posterior wall of the trachea are likely related to mucous as they were not visible on the prior exam. There is normal vascular enhancement within the neck without evidence of focal aneurysm or stenosis. Mild inflammatory changes surrounds the right submandibular gland and right thyroid strap muscles, consistent with resolving inflammation. There is no definite residual solid or cystic mass lesion.
Scattered emphysematous changes are noted in the lung apices. Thoracic inlet structures are otherwise unremarkable.

Impression: Mild residual inflammatory change in the right thyroid strap muscles and right submandibular gland, not unexpected given the clinical history. There is no evidence of residual solid or cystic mass lesion.