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Last visited 09-03-2010 080311 NECK ABSCESS WITH PULMONARY SEPTIC EMBOLI Random Case
Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 3 month old male
History:

Chief complain:
An ill-defined, erythematous, tender, warmish mass over right face and neck since this morning.
Intermittent fever for days (+). No obvious skin wound.

Travel history:
He went to Tainan (a city also in Taiwan) with his family for trip days ago.

Birth history:
G1P1
Gestational age: 40 weeks, C/S
Birth body weight: 4200 gm

Laboratory data:
Decreased WBC: 2830 /mm3 (Band 30%, Seg 34%, Lymho 25%).
Increased C.R.P: 18.5 mg/dl

Images:[small]mediumlargeas-submittedimages only

Fig. 1

Fig. 2

Fig. 3: CT scan of neck post IV contrast

Fig. 4: CT scan of neck post IV contrast

Fig. 5: CT scan of upper chest before IV contrast
Images:[small]mediumlargeas-submittedimages only
Findings:

CT csan of neck with pre- and post- intravenous contrast, and
 with multiplanar reconstruction:

1. Marked swelling of right parotid gland with extensive lobulated
   fluid accumulation (red arrow in figure 3 and 4), compatible with
   infectious process with abscess. Presence of derect extension of
   the fluid into adjacent right parapharyngeal, retropharyngeal, and
   paraspinal portion of right perivertebral spaces.
   Besides, the lesion also extension into right posterior cheek
   soft tissue and along right lateral neck into supraclavian fossa.
2. Presence of mass effect of the above lesion with compression
   of larynx causing airway moderate stenosis (yellow arrow in figure
   3 and 4). Please check it!
3. Swelling of left parotid gland with multiple cystic foci
   and derect extension into adjacent paraspinal portion of
   left perivertebral space also.
4. Peribronchial infiltration in both lungs with two nodules in
   both lungs (green arrows in figure 5) and a cavity lesion in right
   upper lung (blue arrow in figure 5), infectious process such as
   septic emboli can not be excluded.

Impression:
1. Infectious process in bilateral parotid glands, predominant over
   right side, with abscess formation and airway compression.
2. Suspicious septic emboli, both lungs.

Diagnosis: Neck abscess with pulmonary septic emboli
(Blood culture: Streptococcus pyogenes)
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Additional Details:

Case Number: 13906737Last Updated: 03-20-2008
Rating:

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Anatomy: Face and Neck   Pathology: Infection
Modality: CT, PhotographAccess Level: Readable by all users
Keywords: septic emboli, abscess, streptococcusACR: 28.2013
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