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CT Neck Laryngeal Abscess

FINDINGS: There is an ill-defined fluid and gas containing collection within the subglottic posterior visceral space soft tissues at the level of the thyroid cartilage, measuring 2.1 cm in mediolateral dimension, 1.1 cm in AP dimension, and 2.1 cm in craniocaudal dimension. The collection is surrounded by enhancing subglottic mucosa. Soft tissue swelling extends into the true and false vocal cords. There is severe airway narrowing at this level and near complete obliteration of the pyriform sinuses. There is no inferior extension below the C6 level. There are multiple prominent lymph nodes along the carotid sheath, measuring up to 9 mm in short axis, likely reactive.
The remainder of the visualized fascial planes and neck spaces are unremarkable. The vessels of the skull base and neck demonstrate normal course and caliber without filling defect. There is polypoid mucosal thickening of the left maxillary and sphenoid sinuses. There is reversal of the normal lordotic curvature of the cervical spine and early degenerative disc disease at the C6-C7 level.

IMPRESSION: Posterior subglottic gas and fluid collection with edema and swelling of the true and false cords may represent laryngeal abscess versus hematoma. There is severe narrowing of the airway as above.

COMPARISON: CT of the neck from [].
FINDINGS: There has been interval placement of a tracheostomy tube. Transpatial and upper mediastinal emphysema is noted which is likely secondary to surgical intervention. There is significant subglottic narrowing and tracheal edema from the hyoid extending inferiorly to the level of the true vocal cords. There is no evidence of pneumothorax within the visualized
portions of the lung.
The peripherally enhancing infrahyoid retropharyngeal fluid collection consistent with abscess demonstrates interval increase in size currently measuring 3.8 cm in mediolateral dimension, 2.4 cm in AP dimension and 4.2 cm in craniocaudal dimension (previously measured 2.1 x 1.1 x 2.1 cm
respectively). A punctate calcification is again visualized within the posterior portion of the abscess.
Multiple enlarged lymph nodes along the bilateral carotid sheaths are stable in appearance and likely reactive. The vasculature of the skull base and neck demonstrate normal course and caliber without filling defect. The previously described chronic sinus disease and degenerative changes of the cervical spine are stable in appearance.

1. Peripherally enhancing subglottic retropharyngeal fluid collection larger since the prior study compatible with worsening abscess. There is a punctate calcification on the posterior portion of the abscess, which possibly post traumatic or less likely foreign body given the abscess.
2. Transpatial and upper mediastinum emphysema probably post surgical.