Imaging of Acute Head and Neck Infections

Tonsillar infection is the most common cause of infections of the neck in children and young adults whereas odontogenic infection is the most common cause in older population groups. Other sources of neck infection include the salivary glands, nasal sinuses, middle ear and mastoids, cervical lymph nodes, and trauma. Computed tomography and magnetic resonance imaging have excellent sensitivity for the recognition of deep infections, particularly for the identification of abscess formation and its precise location and extension of disease. A careful assessment of potential severe complications, such as vascular compromise, osteomyelitis, and airway narrowing, should be performed routinely

Role of multidetector computed tomography in the assessment of cervical spine trauma

Clearing the cervical spine has relied on individual and center-based experience. Not long ago, the screening modality of choice was radiography. The evidence now clearly supports multidetector computed tomography as the modality of choice for evaluating cervical spine trauma because of its higher accuracy and efficiency compared to radiography. Furthermore, clinical criteria have been validated to assess for cervical spine injuries and determine the need for imaging evaluation based on patient risk. Once imaging is deemed necessary to exclude cervical spine injury based on clinical predictors, multidetector computed tomography becomes the accepted modality of choice, providing accurate and rapid assessment and improving the understanding of injury patterns and stability determinants

Trauma to the ankylotic spine: imaging spectrum of vertebral and soft tissue injuries

The objectives of the study were to review the clinical entities that can cause ankylosis of the spine and to illustrate the spectrum of traumatic injury patterns. Ankylosing spondylitis, diffuse idiopathic systemic hyperostosis, degenerative spondyloarthropathy, and spinal canal stenosis can render the spine susceptible to trivial trauma. Multidetector computed tomography and magnetic resonance imaging can accurately diagnose vertebral and soft tissue traumatic injury patterns in this patient population

An unusual presentation of fish bone ingestion in an adolescent girl – A case report

Fish bones are common foreign bodies encountered in the throat. Fish bones may migrate downward if they are not removed early. Rarely, they are embedded in the soft tissue causing retropharyngeal abscess (RPA) formation. RPA needs prompt diagnosis and early management which often requires surgical drainage to achieve optimum result. The diagnosis is based on clinical and radiological pictures. The management needs securing of the airway, surgical drainage and antibiotics. We report a case of ingested foreign body of fish bone presented with RPA after one month of ingestion in a 15 year old girl. Imaging confirmed the fish bone in the retropharyngeal space, which was removed by transoral approach

Irreversible Electroporation of Hepatic and Pancreatic Malignancies: Radiologic-Pathologic Correlation

Irreversible electroporation (IRE) is a novel therapy that has shown to be a feasible and promising alternative to conventional ablative techniques when treating tumors near vital structures or blood vessels. The clinical efficacy of IRE has been evaluated using established imaging criteria. This study evaluates the histologic and imaging response of hepatic and pancreatic malignancies that were surgically resected after IRE. In total, 12 lesions ablated with IRE were included, including 3 pancreatic carcinomas, 5 primary tumors of the liver, and 4 metastatic tumors of the liver. The rate of complete response to IRE was 25% based on the histologic evaluation of the resected tumors. Although treatment-related vessel wall changes were noted in several cases in histologic findings, there was no evidence of vascular luminal narrowing or obliteration in any of the specimens. The imaging response to IRE before surgical resection usually resulted in underestimation of disease burden when compared with the histologic response seen on the resected specimens

Imaging utilization in the management of appendicitis and its impact on hospital charges

The objective of this study is to assess the trends in imaging utilization in adults with diagnosis of appendicitis and the role that imaging plays in the escalating appendicitis hospital charges. Data on demographics, imaging utilization, and charges of all patients discharged after a diagnosis of appendicitis during 6 years (1999-2004) were obtained from the integrated database of a large hospital. The number of discharges from 1999 to 2004 in the institution steadily decreased. An average of 2.34 imaging studies per patient were obtained, increasing from 1.85 in 1999 to 3.07 in 2004 (p=0.001). Computed tomography (CT) studies represented 65.9% of the total of studies obtained, while plain films and ultrasound represented 19 and 14%, respectively. The percentage of patients who underwent CT increased from 51.4 to 75.7%, with relative decreases of 12 and 54% for plain abdominal films and ultrasound, respectively. Patients older than 65 years had higher rates of imaging utilization, averaging 4.3 compared with 1.86 studies in their younger counterparts (p=0.001). Imaging utilization rates did not significantly differ among races (p>0.5), genders (p>0.8), discharge services (p>0.1), or payer groups (p>0.5). Average hospital charges for appendicitis increased by 16.3%, while imaging charges increased as a fraction of hospital charges from 7.89 to 10.87%. Imaging utilization has increased rapidly, but trends show a slowdown that might correspond with achievement of standardization. This suggests that longterm continuous rising is unlikely. Imaging charges correlate with increased hospital charges but cannot explain or accurately predict them