Head &Neck 911 Imaging of Neck & Airway Emergencies Michelle A. Michel, M. D. Professor of Radiology and Otolaryngology Medical College of Wisconsin, Milwaukee, WI Disclosure of Commercial Interest • Neither I nor my immediate family (that would be my Bichon Frise “GoGo”) have a financial relationship with a commercial organization that may have a direct or indirect interest in the content of this presentation. Illustrations courtesy Elsevier & Amirsys, Inc. A big thanks to Drs. Philip Chapman, Rebecca Cornelius, Bernadette Koch, C. Douglas Phillips, & Deborah Shatzkes for case material!!! Neck & Airway Emergencies Objectives • Review emergent, non- traumatic adult conditions of the neck • Emphasize imaging findings to make the correct diagnosis, identify secondary findings, and recognize potential complications • Topics • Neck space infection/inflammation • Conditions affecting the airway • Non-traumatic vascular lesions Neck & Airway Emergencies Overview • What constitutes a H&N Emergency ? • Condition is life threatening • Condition could cause loss of function • Condition causes severe pain or distress • Condition that if not identified early may result in a situation that is life-threatening, causes loss of function or severe pain/distress • Vital anatomy in the H&N • Airway, vasculature, neural elements • In close proximity • Big problems if findings missed or misinterpreted! Jean-Baptiste Marc Bougery (1831-1854) Neck & Airway Emergencies Imaging Approach • Conventional radiographs & MRI have little role in acute setting • CT is primary imaging modality in emergent H&N conditions • Fast image acquisition • Relatively insensitive to patient motion • Large FOV & high spatial resolution • Reformatted images from single acquisition • Widely available • Benefits in emergent setting outweigh risks of radiation exposure • Dose-limiting technologies • Role of imaging • Identify location & source • Assess anatomic extension – pattern of spread • Orbit, intracranial, airway, vessles, thoracic cavity • Detect complications • Guide drainage Neck & Airway Emergencies Neck Space Infection & Inflammation
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Head &Neck 911Imaging of Neck & Airway Emergencies
Michelle A. Michel, M. D.Professor of Radiology and Otolaryngology
Medical College of Wisconsin, Milwaukee, WI
Disclosure of Commercial Interest• Neither I nor my immediate family (that
would be my Bichon Frise “GoGo”) have
a financial relationship with a
commercial organization that may have
a direct or indirect interest in the content
of this presentation.
Illustrations courtesy Elsevier & Amirsys, Inc.
A big thanks to Drs. Philip Chapman, Rebecca
Cornelius, Bernadette Koch, C. Douglas Phillips, &
Deborah Shatzkes for case material!!!
Neck & Airway EmergenciesObjectives
• Review emergent, non-
traumatic adult conditions of
the neck
• Emphasize imaging findings to
make the correct diagnosis,
identify secondary findings,
and recognize potential
complications
• Topics
• Neck space
infection/inflammation
• Conditions affecting the airway
• Non-traumatic vascular lesions
Neck & Airway EmergenciesOverview
• What constitutes a H&N
Emergency?• Condition is life threatening
• Condition could cause loss of function
• Condition causes severe pain or distress
• Condition that if not identified early may result
in a situation that is life-threatening, causes
loss of function or severe pain/distress
• Vital anatomy in the H&N• Airway, vasculature, neural elements
• In close proximity
• Big problems if findings missed or
misinterpreted!Jean-Baptiste Marc Bougery
(1831-1854)
Neck & Airway EmergenciesImaging Approach
• Conventional radiographs & MRI
have little role in acute setting
• CT is primary imaging modality
in emergent H&N conditions
• Fast image acquisition
• Relatively insensitive to patient
motion
• Large FOV & high spatial resolution
• Reformatted images from single
acquisition
• Widely available
• Benefits in emergent setting outweigh
risks of radiation exposure
• Dose-limiting technologies
• Role of imaging
• Identify location &
source
• Assess anatomic
extension – pattern of
spread
• Orbit, intracranial, airway,
vessles, thoracic cavity
• Detect complications
• Guide drainage
Neck & Airway EmergenciesNeck Space Infection & Inflammation
Neck & Airway EmergenciesNeck Space Infection & Inflammation
• Glandular “emergencies”
• Tonsillitis & peritonsillar
abscess
• Acute calcific prevertebral
tendonitis
• Odontogenic infection
• Floor of mouth infection
(Ludwig angina)
• Deep neck space infection
• Necrotizing fasciitis
57 year old male with left neck swelling & pain
Neck & Airway EmergenciesGlandular “Emergency”
Acute Submandibular Sialolithiasis-adenitis
Neck & Airway EmergenciesAcute Sialoadenitis
• Facial swelling & tenderness
↑ by oral intake
• Parotitis – CN7 paresis
• Obstructing sialolith
• 80-90% of acute cases
• SMG (70-80%)
• Large, ascending duct & small
papillary orifice, ↑ secretion
viscosity & slow flow rate
• No stone?...look for anterior
FOM mass!
Acute on Chronic
Sialolithiasis/Sialoadenitis
Neck & Airway EmergenciesSialoadenitis
63 year old male with tongue pain and neck swelling