Presentation
Acute onset of odynophagia, dysphagia, fever and left neck swelling.
Patient Data
Multiple ill-defined fluid collections filling the left pharyngeal mucosal space, left visceral space, left anterior cervical space and retropharyngeal space. These collections do not have significant obvious peripheral rim enhancement. The retropharyngeal space fluid collection appears to extend inferiorly to involve the superior mediastinum with significant fat stranding in the superior mediastinum, suspicious of mediastinitis without well-formed mediastinal abscess. No abnormal air locules seen within these fluid collections. Ill-defined hypodensity seen at anterior aspect of left sternocleidomastoid muscle, suspicious of phlegmon or early intramuscular abscess formation.
Both tonsils are enlarged without internal hypodensity to suggest collection or tonsilitis. No radioopaque foreign bodies seen.
Minimal mucosal thickening at both maxillary sinuses.
Epiglottis and aryepiglottic folds are not thickened.
Bilateral common carotid arteries and internal jugular veins are well opacified without thrombosis.
Case Discussion
Overall CT features are suggestive of left neck necrotizing fasciitis. Proceeded with urgent emergency surgery as incision and drainage, where intraoperatively noted frank pus at multiple left deep neck spaces as well as retropharyngeal space.
Necrotizing fasciitis is the preferred radiological diagnosis compared to neck abscesses as the fluid collections appear to be ill-defined and bizarre shaped without significant rim enhancement. The fluid collections are in different fascial planes of deep neck spaces and multiple neck space compartments. Although necrotizing fasciitis usually has air locules/gas pockets, it can present without air locules. (Necrotizing fasciitis of neck with extensive air locules can refer to this case).
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