MR Imaging Evaluation of Pediatric Neck Masses:

Congenital Cystic Neck Masses

Congenital cystic masses are commonly encountered when imaging a patient presenting with a neck mass. Congenital cysts are present at birth; however, these cysts may not present until later in life with some growing slowly and others rapidly increasing in size due to hemorrhage of infection. A neonatal presentation is rare but when present may allow a narrower differential diagnosis. Imaging plays a significant role in defining a lesion as cystic, assessing location, and directing the next step in evaluation and or intervention.

Pictorial Review of MRI Findings in Acute Neck Infections in Children

Pediatric neck infections and their complications, such as abscesses extending to deep neck compartments, are potentially life-threatening acute conditions. Medical imaging aims to verify abscesses and their extensions and exclude other complications. Magnetic resonance imaging (MRI) has proven to be a useful and highly accurate imaging method in acute neck infections in children. Children and adults differ in terms of the types of acute infections and the anatomy and function of the neck. This pictorial review summarizes typical findings in pediatric patients with neck infections and discusses some difficulties related to image interpretation.

Postauricular Cyst in a 15-Year-Old Girl

A 15-year-old girl presented with a right-side postauricular mass, which showed high signal intensity on T2-weighted magnetic resonance imaging and lining by squamous epithelium on histopathological examination after surgical excision. What is your diagnosis?

Oropharyngeal neuroglial choristoma with extension into the parapharyngeal space

Oropharyngeal neuroglial choristomas are exceptionally rare head and neck tumours that contain mature neuroglial tissue. We report a case of neuroglial choristoma centred in the oropharynx and extending into the parapharyngeal space that, to the best of our knowledge, is the only case whose appearance simulated brain cortical gyri with an apparent differentiation between white and grey matter. We illustrate and detail the magnetic imaging findings of oropharyngeal choristoma that might help to establish a correct preoperative diagnosis.

Pediatric Neck Masses: Imaging Guidelines and Recommendations

Neck masses commonly present in children and several potential diagnostic and management pathways exist, though with a paucity of evidence-based recommendations. The purpose of this article is to evaluate the current literature and utilization of various diagnostic imaging modalities , with a review of imaging features and management pearls for pediatric neck masses. A comprehensive understanding and practical imaging workflow will guide optimal patient workup and management.

Early surgical intervention enhances recovery of severe pediatric deep neck infection patients

PURPOSE

Pediatric deep neck space infection (DNI) is a relatively rare but potentially life-threatening condition and requires prompt and accurate management. This study retrospectively reviews our experience in a tertiary referral hospital from 2004 to 2019.

METHODS

Systematic data collection from medical records using ICD10 codes between 2004 and 2019.

INCLUSION CRITERIA

age ≤16 years, DNI requiring hospitalization and/or surgery. EXCLUSION: peritonsillar abscess without complications.

RESULTS

We identified 42 patients, 21 boys and 21 girls, with a median age of 4.9 years. Most of the patients had severe symptoms, the most common of which were neck swelling (n = 39; 92.9%), neck pain (n = 39; 92.9%) and fever (n = 32; 76.2%). Twenty-two (52.4%) had torticollis, and the mean duration of symptoms before hospitalization was 4.95 days. Diagnosis was confirmed by MRI (n = 24), contrast-enhanced CT (n = 11) or ultrasonography (n = 6), except in one case. Twenty-three (54.8%) required an open neck incision, ten (23.8%) patients had intraoral surgery and nine were treated conservatively. Twelve (28.6%) patients were admitted to the pediatric ICU. Median hospitalization duration was six days. The infection most commonly had tonsillopharyngeal etiology (n = 18) and a retropharyngeal location (n = 17). Staphylococcus Aureus (n = 7) and Streptococcus pyogenes (n = 7) were the most frequent pathogens. We compared the early surgical intervention group (<2 days of intravenous antibiotics; n = 18; 42.9%) to the late surgery group (n = 15; 35.7%) and the conservatively treated groups (n = 9; 21.4%). The overall length of stay (LOS) was lower in the shorter preoperative medication group (mean 4.4 vs. 7.2; p = 0.009). The size of the abscess did not differ between the groups (mean 28 mm; 30 mm; 21 mm; p = 0.075) and the neck incision rate was similar in the operated groups.

CONCLUSION

Early surgical intervention is associated with decreased LOS among severe pediatric DNI patients.

Oropharyngeal neuroglial choristoma with extension into the parapharyngeal space

Oropharyngeal neuroglial choristomas are exceptionally rare head and neck tumours that contain mature neuroglial tissue. We report a case of neuroglial choristoma centred in the oropharynx and extending into the parapharyngeal space that, to the best of our knowledge, is the only case whose appearance simulated brain cortical gyri with an apparent differentiation between white and grey matter. We illustrate and detail the magnetic imaging findings of oropharyngeal choristoma that might help to establish a correct preoperative diagnosis.