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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. Pediatrics 2024; 154:e2024066855. [PMID: 38932719 DOI: 10.1542/peds.2024-066855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2024] [Indexed: 06/28/2024] Open
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging, are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Marin JR, Lyons TW, Claudius I, Fallat ME, Aquino M, Ruttan T, Daugherty RJ. Optimizing Advanced Imaging of the Pediatric Patient in the Emergency Department: Technical Report. J Am Coll Radiol 2024; 21:e37-e69. [PMID: 38944445 DOI: 10.1016/j.jacr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
Advanced diagnostic imaging modalities, including ultrasonography, computed tomography, and magnetic resonance imaging (MRI), are key components in the evaluation and management of pediatric patients presenting to the emergency department. Advances in imaging technology have led to the availability of faster and more accurate tools to improve patient care. Notwithstanding these advances, it is important for physicians, physician assistants, and nurse practitioners to understand the risks and limitations associated with advanced imaging in children and to limit imaging studies that are considered low value, when possible. This technical report provides a summary of imaging strategies for specific conditions where advanced imaging is commonly considered in the emergency department. As an accompaniment to the policy statement, this document provides resources and strategies to optimize advanced imaging, including clinical decision support mechanisms, teleradiology, shared decision-making, and rationale for deferred imaging for patients who will be transferred for definitive care.
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Affiliation(s)
- Jennifer R Marin
- Departments of Pediatrics, Emergency Medicine, & Radiology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Todd W Lyons
- Division of Emergency Medicine, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts
| | - Ilene Claudius
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, California
| | - Mary E Fallat
- The Hiram C. Polk, Jr Department of Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky
| | - Michael Aquino
- Cleveland Clinic Imaging Institute, and Section of Pediatric Imaging, Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland Clinic Children's Hospital, Cleveland, Ohio
| | - Timothy Ruttan
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin; US Acute Care Solutions, Canton, Ohio
| | - Reza J Daugherty
- Departments of Radiology and Pediatrics, University of Virginia School of Medicine, UVA Health/UVA Children's, Charlottesville, Virginia
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Trott S, Burruss CP, Weltzer M, Iverson K, Azbell C, Bush ML. Perioperative factors influencing hospitalization duration for pediatric neck abscesses. Am J Otolaryngol 2023; 44:103967. [PMID: 37454430 DOI: 10.1016/j.amjoto.2023.103967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE Pediatric neck abscesses are a common pathology seen in an ambulatory setting. Although some pediatric neck abscesses are managed medically with antibiotics, surgical intervention is often required. Given the often non-emergent presentation of many abscesses, a variety of logistical and perioperative factors may delay time to care and subsequently prolong hospital stay. The objective of this study was to examine factors that influence the overall time to surgery (TTS) and hospital length of stay (LOS) in a pediatric population with neck abscesses who ultimately require surgical drainage. MATERIALS AND METHODS 161 pediatric patients who underwent incision and drainage of a neck abscess over a ten-year period at a tertiary referral children's center were reviewed. Demographic information, radiographic studies, and surgical information were extracted from patient charts. Descriptive statistics, Mann-Whitney U tests, and multivariate analyses were performed. RESULTS The most common subcategory location was deep neck abscesses (33.1 %). Computed tomography (CT) was the most common pre-operative imaging modality (54.1 %) followed by ultrasound (US) (49.1 %) and magnetic resonance imaging (2.6 %). US and a combination of multiple preoperative imaging modalities were associated with increased LOS and TTS. Repeat surgery was associated with increased LOS. Pre-admission antibiotic use was associated with increased LOS and TTS. Younger patients were more likely to have a longer LOS. CONCLUSIONS A variety of factors can influence TTS, LOS, and time from surgery to discharge including patient age, abscess location, a non-optimized utilization of imaging modalities, the utilization of pre-admission antibiotics, and the need for repeat operations.
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Affiliation(s)
- Skylar Trott
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | | | | | - Kenneth Iverson
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Chris Azbell
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Matthew L Bush
- Department of Otolaryngology, University of Kentucky Medical Center, Lexington, KY, USA.
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Ramazani F, Yunker WK, Liu CC. Sensitivity and Specificity of US and CT as Diagnostic Tools for Pediatric Lateral Neck Abscesses. Otolaryngol Head Neck Surg 2023; 168:1529-1534. [PMID: 36939468 DOI: 10.1002/ohn.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/04/2022] [Accepted: 11/02/2022] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Ultrasound (US) and computed tomography (CT) are commonly used in the diagnosis of pediatric neck abscesses. The objective of this study is to determine the sensitivity and specificity of US and CT in the diagnosis of pediatric lateral neck abscesses, with a secondary objective of evaluating the association of specific clinical features with a positive US or CT scan. STUDY DESIGN Retrospective review of pediatric patients admitted to a tertiary care center from January 1, 2011, to December 31, 2020, with neck abscesses. SETTING Tertiary care center. METHODS The sensitivity and specificity of US and CT were calculated by comparing imaging performed within 24 h of incision and drainage (I&D). Multiple regression was used to evaluate the association of clinical features with a true positive US or CT. RESULTS There were 171 patients included in this study, with a median age of 1.5 years (interquartile range [IQR]: 1-5 years). I&D was done in 156 patients (91.2%), while 15 (8.8%) were treated with antibiotics. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of US were 69.5%, 80%, 96.6%, and 24.2%. The sensitivity, specificity, PPV, and NPV of neck CT were 95.5%, 80%, 95.5%, and 57.1%. Length of symptoms, skin erythema, and fluctuance were not significantly associated with a positive US (F(3, 82) = 0.24, p = .9, R2 = 0.01) or CT scan (F(3, 30) = 0.84, p = .5, R2 = 0.08). CONCLUSION Neck US has a low sensitivity for diagnosing pediatric neck abscesses, when compared to CT, but remains a useful initial investigation given its high PPV. Clinicians should have a low threshold for pursuing CT if there is a high suspicion of abscess formation. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Fatemeh Ramazani
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Warren K Yunker
- Department of Surgery, Section of Otolaryngology-Head and Neck Surgery, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Che Carrie Liu
- Department of Otolaryngology-Head and Neck Surgery, University of Arizona College of Medicine, Tuscon, Arizona, USA
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Evaluation of an imaging protocol using ultrasound as the primary diagnostic modality in pediatric patients with superficial soft tissue infections of the face and neck. Int J Pediatr Otorhinolaryngol 2017; 96:89-93. [PMID: 28390621 DOI: 10.1016/j.ijporl.2017.02.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 02/21/2017] [Accepted: 02/25/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the clinical impact of an initiative to use ultrasound (US) as the primary diagnostic modality for children with superficial face and neck infections versus use of computed tomography (CT). METHODS Children with a diagnosis of lymphadenitis, face or neck abscess, or face and neck cellulitis were retrospectively evaluated by the otolaryngology service. Patients were separated into two groups based on implementation of a departmental initiative to use US as the primary diagnostic modality. The pre-implementation cohort consisted of patients treated prior to the initiative (2006-2009) and the current protocol cohort consisted of patients treated after the initiative was started (2010-2013). Demographics, use of US or CT, necessity of surgical intervention, and failure of medical management were compared. RESULTS Three hundred seventy three children were evaluated; 114 patients were included in the pre-implementation cohort and 259 patients were included in the current protocol cohort for comparison. Patients presenting during the current protocol period were more likely to undergo US (pre-implementation vs. current protocol, p-value) (12% vs. 49%, p < 0.0001) and less likely to undergo CT (66% vs. 41%, p < 0.0001) for their initial evaluation. There were no differences in the percentage of children who underwent prompt surgical drainage, prompt discharge without surgery, or trial inpatient observation. There were also no differences in the rate of treatment failure for patients undergoing prompt surgery or prompt discharge on antibiotics. For those patients who underwent repeat evaluation following trial medical management, US was used more frequently in the current protocol period (4% vs. 20%, p = 0.002) with no difference in CT use, selected treatment strategy, or treatment failure rates. CONCLUSION Increased use of US on initial evaluation of children with superficial face and neck infections resulted in decreased CT utilization, without negatively impacting outcome. Decreasing pediatric radiation exposure and potential long-term effects is of primary importance.
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Kwon M, Seo JH, Cho KJ, Won SJ, Woo SH, Kim JP, Park JJ. Suggested Protocol for Managing Acute Suppurative Cervical Lymphadenitis in Children to Reduce Unnecessary Surgical Interventions. Ann Otol Rhinol Laryngol 2016; 125:953-958. [PMID: 27553593 DOI: 10.1177/0003489416665194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The indications and benefits of surgery in the management of pediatric acute suppurative cervical lymphadenitis (ASCL) remain unclear. We aimed to design a management protocol focusing on the avoidance of unnecessary operation in pediatric ASCL patients. METHODS The study population consisted of 45 pediatric patients with ASCL treated with antibiotics alone and 30 surgically treated patients. The primary outcome was the determination of differences in patient characteristics and radiologic findings in the 2 groups. The secondary outcome, after matching 20 cases with 20 controls, was to determine the benefits of surgery to patients. RESULTS There were no significant differences between the 2 groups in patient characteristics and radiologic findings at initial presentation. In the matched case-control analysis, intravenous antibiotics alone yielded successful treatment outcomes when compared with surgery, with no significant differences in time to symptom resolution, normalized laboratory test results, and duration of hospitalization (all P > .05). CONCLUSIONS The size and location of suppurated lymph nodes are not absolute determinants for surgical drainage in the stable pediatric ASCL patients. If patients show no clinical improvements despite appropriate second- and third-line antibiotics, patients should be carefully reevaluated and image-guided aspiration considered.
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Affiliation(s)
- Minsu Kwon
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji-Hyun Seo
- Departments of Pediatrics, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Gangnam-ro Jinju, Republic of Korea
| | - Ki Ju Cho
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seong Jun Won
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Seung Hoon Woo
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jin Pyeong Kim
- Departments of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung Je Park
- Department of Otorhinolaryngology, Gyeongsang National University School of Medicine, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Martins FL, Salum FG, Cherubini K, de Figueiredo MAZ. Utility of ultrasonography as an auxiliary method in the diagnosis of lesions in oral soft tissues. Oral Radiol 2015. [DOI: 10.1007/s11282-015-0199-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Correlation between pre-operative diagnosis and post-operative pathology reading in pediatric neck masses--a review of 281 cases. Int J Pediatr Otorhinolaryngol 2015; 79:2-7. [PMID: 25479698 DOI: 10.1016/j.ijporl.2014.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 11/05/2014] [Accepted: 11/07/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Describe the pre-operative diagnosis correlation of pediatric neck masses with the final post-operative pathology reading. Evaluate if added imaging studies were associated with higher frequency of correct diagnosis. STUDY DESIGN Retrospective case series review. SETTING Tertiary Academic Medical Center. SUBJECTS AND METHODS Data was collected from 281 pediatric patients with an undiagnosed neck mass that underwent open biopsy from January 1986 to December 2011. Data collection included pre-operative accuracy and relative contributions of clinical clues and imaging studies. RESULTS Pre-operative and post-operative diagnoses match varied for each category of diagnoses. The difference in distribution of correct pre-operative diagnoses between 6 categories of neck masses was statistically significant. The highest number of cases with correct pre-op diagnosis was seen with congenital masses which were correctly diagnosed with 75% of cases (n=109), followed by benign tumors which were diagnosed with 73.7% of cases (n=19). When CT scans were included in the pre-op work up, it was associated with a non-significant trend toward a less frequent correlation between pre and post-operative diagnosis in congenital, nodal inflammatory and miscellaneous masses. However, with regards to the diagnosis of benign tumors, CT scan was associated with a trend toward higher proportion of correct pre-op diagnosis. In cases where US was included in the evaluation, we found a trend toward less frequent correlation with post op diagnosis in benign tumors, nodal inflammatory, non-nodal inflammatory and miscellaneous diagnoses and an increase in accuracy for congenital masses. CONCLUSION Certain types of pediatric neck masses are easy to diagnose likely due to their classic presentation. Failure to diagnose masses often occurs when the clinical picture is vague or non-specific. Ancillary imaging studies do not always correlate with increased accuracy of diagnosis, particularly when the clinical clues are typical.
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Martins FL, Salum FG, Cherubini K, Oliveira R, de Figueiredo MAZ. Contribution of Ultrasonography to the Diagnosis of Submucosal and Subcutaneous Nodular Lesions of the Oral and Maxillofacial Region: Analysis of Cases. J Maxillofac Oral Surg 2014. [PMID: 26225066 DOI: 10.1007/s12663-014-0714-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the contribution of ultrasonography in the establishment of the diagnosis of nonspecific nodular lesions of the oral soft tissues. We determined the indication of use and reliability of ultrasonography in the field of dentistry, considering whether it was of value in the conclusive diagnosis of these pathologies. MATERIALS AND METHODS We recruited 65 patients from the Oral Medicine Unit of São Lucas Hospital, who had submucosal and subcutaneous nodules, without established diagnosis. They were subjected to ultrasonography of the lesion, carried out with standardization of the protocol and equipment, utilizing a Doppler system. The ultrasonographic report was prepared by an experienced professional, noting the imaging characteristics as well as the possibility of diagnosis. Two calibrated examiners analyzed the data, comparing the ultrasonographic report with the final diagnosis. Accordingly, we used established scoring, where zero corresponded to no contribution to the final diagnosis, 1 helped in the management of the case, and 2 when imaging determined the diagnosis. RESULTS A zero score was obtained for 12.3 % of the examinations performed, and 1 and 2 accounted for respectively 41.5 and 46.1 %, totaling a contribution of about 88 %. Ultrasonography was of value in the diagnosis of vascular lesions in 93.3 % and of neoplasms in 87.5 %. In the salivary gland diseases, it contributed to the final diagnosis in 75 %. CONCLUSION The results demonstrated that ultrasonography is an effective tool in the determination of the definitive diagnosis of nonspecific nodular lesions of the soft tissues of the oral and maxillofacial region.
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Affiliation(s)
- Felipe Leal Martins
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil
| | - Fernanda Gonçalves Salum
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil
| | - Karen Cherubini
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil
| | - Roberto Oliveira
- Brazilian College of Radiology, São Paulo, Brazil ; Clinical Radiology Unit, Radiology and Ecography Foundation of Rio Grande do Sul, Rio Grande do Sul, Brazil
| | - Maria Antonia Zancanaro de Figueiredo
- Oral Medicine Unit, São Lucas Hospital, Dentistry School, Pontifical Catholic University of Rio Grande do Sul (PUCRS), 6690 Ipiranga avenue - 2nd floor/room 231, Porto Alegre, RS CEP 90610-000 Brazil ; Serviço de Estomatologia do Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av. Ipiranga, 6690 - 2º andar/sala 231, Porto Alegre, RS CEP 90610-000 Brazil
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Collins B, Stoner JA, Digoy GP. Benefits of ultrasound vs. computed tomography in the diagnosis of pediatric lateral neck abscesses. Int J Pediatr Otorhinolaryngol 2014; 78:423-6. [PMID: 24485972 DOI: 10.1016/j.ijporl.2013.11.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2013] [Revised: 11/27/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE There are no studies comparing the accuracy of ultrasound and computed tomography in the same population of pediatric patients with lateral neck abscesses. This case series assesses the accuracy of the two imaging techniques. METHODS One hundred and forty imaging studies (ultrasound n=39 or CT n=101) that were performed from 2005 to 2011 prior to incision and drainage of a lateral neck mass at a tertiary care academic institution were retrospectively reviewed. All children 0-18 years of age with lateral neck abscesses who underwent CT or ultrasound imaging prior to drainage were included. Sensitivity, specificity, and positive and negative predictive values of ultrasound and CT were determined as compared to the gold standard, incision and drainage of the suspected abscess. RESULTS In children undergoing incision and drainage, the prevalence of an abscess was 89%. Ultrasound has a high specificity (100%) but a low sensitivity (53%). The positive predictive value (96%) is high while the negative predictive value is low (16%), assuming a positive abscess prevalence of 0.9. In contrast, CT has low specificity (18%) but slightly higher sensitivity (68%) compared to ultrasound. Similar to ultrasound, CT had low negative (6%) and high positive (88%) predictive values. CONCLUSIONS This study demonstrates that ultrasound may be an equivalently sensitive and more specific diagnostic tool when compared to CT in the work-up of lateral neck abscesses in children. It is safe and effective in diagnosis when there is an undetermined probability of an abscess.
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Affiliation(s)
- Benjamin Collins
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, P.O. Box 26901 WP 1290, Oklahoma City, OK 73126-0901, United States.
| | - Julie A Stoner
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 800 NE 13th Street, Oklahoma City, OK 73190, United States.
| | - G Paul Digoy
- Department of Otorhinolaryngology, University of Oklahoma Health Sciences Center, P.O. Box 26901 WP 1290, Oklahoma City, OK 73126-0901, United States.
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Hegde AN, Mohan S, Pandya A, Shah GV. Imaging in Infections of the Head and Neck. Neuroimaging Clin N Am 2012; 22:727-54. [DOI: 10.1016/j.nic.2012.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
A case report is presented of a sonographic examination at 39 weeks’ gestation that showed a nonvascular fetal oral mass. The patient was transferred to a tertiary referral hospital where an ex utero intrapartum treatment (EXIT) procedure was planned; however, delivery was subsequently completed without the need of this procedure. The neonate underwent marsupialization of the mass with the final diagnosis of a ranula or lymphangioma. This case report emphasizes identification of a fetal oral mass, appropriate diagnostic tools to evaluate oral masses, and treatment options for these patients.
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Mallorie CNJ, Jones SD, Drage NA, Shepherd J. The reliability of high resolution ultrasound in the identification of pus collections in head and neck swellings. Int J Oral Maxillofac Surg 2011; 41:252-5. [PMID: 22103998 DOI: 10.1016/j.ijom.2011.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 12/08/2010] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
Abstract
Head and neck swellings often present to oral and maxillofacial surgeons. It is often unclear whether a collection of pus is present. This information is essential for decisions regarding surgical intervention. Although ultrasound scanning (USS) is widely used to investigate the presence of a collection, the reliability and validity of this investigation in this context is uncertain. A retrospective review of 4000 consecutive head and neck USS reports over a 4 year period in the Cardiff University Health Board produced 43 cases in which ultrasound had been used to look for evidence of pus collection. The management and treatment outcome of these patients were reviewed and the data analysed. 36 of 43 patients had their swelling incised in theatre, and in 92% of these cases USS and clinical findings corresponded. Of the seven not taken to theatre, four were USS negative and three USS positive; in all seven cases the swelling resolved with antimicrobial therapy. Sensitivity and specificity of USS imaging to identify pus collection were very high, 96% and 82%, respectively. The evidence in this study indicates that USS is a very reliable diagnostic tool in the diagnosis of a collection as well as providing evidence that small collections of pus can resolve without surgical drainage.
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Affiliation(s)
- C N J Mallorie
- The Department of Oral & Maxillofacial Surgery, University Hospital of Wales, Cardiff and Vale NHS Trust, Heath Park, Cardiff, UK.
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Rozovsky K, Hiller N, Koplewitz BZ, Simanovsky N. Does CT have an additional diagnostic value over ultrasound in the evaluation of acute inflammatory neck masses in children? Eur Radiol 2009; 20:484-90. [DOI: 10.1007/s00330-009-1563-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 07/13/2009] [Accepted: 07/27/2009] [Indexed: 11/27/2022]
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Rigante D, La Torraca I, Rossodivita A, De Rosa G, Pantanella A, Delogu AB, Gaspari S, Stabile A. Unilateral cervical mass as a main clue raising the diagnostic suspicion of Kawasaki syndrome. Rheumatol Int 2007; 28:73-6. [PMID: 17564712 DOI: 10.1007/s00296-007-0378-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Accepted: 05/19/2007] [Indexed: 12/28/2022]
Abstract
Unilateral cervical mass and fever were firstly misdiagnosed as bacterial lymphadenitis in a 6-year-old child and empirically treated with antibiotics. Later the child developed the additional features of Kawasaki syndrome and received intravenous immunoglobulins at the eighth day since fever onset with progressive disappearance of the cervical mass and no cardiac sequel. Kawasaki syndrome should be considered in childhood as a relevant cause of cervical lymphadenopathy unresponding to antibiotics: its recognition at an early stage might contribute to anticipate a proper treatment and abate heart complication rate.
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Affiliation(s)
- D Rigante
- Department of Pediatric Sciences, Università Cattolica Sacro Cuore, Rome, Italy.
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Abstract
Imaging the head and neck presents a unique challenge because of the dense concentration of complex anatomy and the importance of lesion localization in formulating the differential diagnosis and prognosis. Critical imaging features such as the ability to define fascial borders of soft tissue neck compartments, the demonstration of intricate anatomy such as the temporal bones and paranasal sinuses, and the noninvasive assessment of vascular integrity have improved greatly in recent years in parallel with the rapid technologic advances in multidetector CT and MRI. After comparing the available imaging techniques, this article explores the imaging findings by anatomic region.
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Affiliation(s)
- Michael C Hurley
- Division of Neuroradiology, Vancouver General Hospital, 899 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9
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Ho EC, McArdle K, Hall A. Is ultrasound useful for evaluating paediatric inflammatory neck masses? Clin Otolaryngol 2006; 31:233; author reply 233-4. [PMID: 16759250 DOI: 10.1111/j.1749-4486.2006.01204.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Douglas S, Elliott S, Parker D. Response to Ho et al. Clin Otolaryngol 2006. [DOI: 10.1111/j.1749-4486.2006.01205.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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