DOI: 10.1148/rg.254045142
Multimodality Imaging Evaluation of the Pediatric Neck: Techniques and Spectrum of Findings1
Jean-Yves Meuwly, MD,
Domenico Lepori, MD,
Nicolas Theumann, MD,
Pierre Schnyder, MD,
Ghazal Etechami, MD,
Judith Hohlfeld, MD and
François Gudinchet, MD
1 From the Departments of Diagnostic and Interventional Radiology (J.Y.M., D.L., N.T., P.S., G.E., F.G.) and Pediatric Surgery (J.H.), University Hospital, Rue du Bugnon 46, Lausanne, Switzerland. Presented as an education exhibit at the 2003 RSNA Annual Meeting. Received July 8, 2004; revision requested August 19 and received September 15; accepted September 17. All authors have no financial relationships to disclose.
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Figure 1. Drawing of a sagittal section of the head and neck region at 4 weeks gestation illustrates the primary stage of development of the thyroid gland.
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Figure 2. Drawing illustrates possible sites of branchial cysts and of skin openings of branchial sinuses and fistulas.
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Figure 3. Drawing illustrates possible locations of lingual and cervical thyroglossal duct cysts. Arrows indicate the migration pathway of the thyroid tissue.
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Figure 4. Diagram illustrates the relationships of the prevertebral (1), danger (2), and parapharyngeal and carotid sheath (3) spaces to the visceral compartment (4) and the submandibular space (5).
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Figure 5a. Drawings of axial sections through the level of C4 (a) and C7 (b) demonstrate the spaces in the upper and midcervical visceral compartment, respectively. IJV = internal jugular vein, PCM = pharyngeal constrictor muscle, PSM = paraspinal muscle, SCM = sternocleidomastoid muscle, T = trachea, TG = thyroid gland, TM = trapezius muscle.
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Figure 5b. Drawings of axial sections through the level of C4 (a) and C7 (b) demonstrate the spaces in the upper and midcervical visceral compartment, respectively. IJV = internal jugular vein, PCM = pharyngeal constrictor muscle, PSM = paraspinal muscle, SCM = sternocleidomastoid muscle, T = trachea, TG = thyroid gland, TM = trapezius muscle.
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Figure 6a. Mature neck teratoma in a 9-month-old boy. (a) Axial proton-density–weighted MR image shows a hyperintense subcutaneous mass in the right side of the neck (arrow). (b) Coronal T2-weighted MR image shows multiple cysts with heterogeneous signal intensity (arrowheads).
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Figure 6b. Mature neck teratoma in a 9-month-old boy. (a) Axial proton-density–weighted MR image shows a hyperintense subcutaneous mass in the right side of the neck (arrow). (b) Coronal T2-weighted MR image shows multiple cysts with heterogeneous signal intensity (arrowheads).
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Figure 7a. Abscesses of the retropharyngeal and danger spaces in a 1-year-old girl. (a) Transverse US image shows a hypoechogenic mass (arrow) between the carotid sheath (*) and the vertebral body (VB), a finding that represents a retropharyngeal abscess. (b) Contrast-enhanced CT scan shows two heterogeneous hypoattenuating masses, one in the left retropharyngeal space with peripheral rim enhancement (arrow), and the other on the midline, in the danger space (arrowhead).
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Figure 7b. Abscesses of the retropharyngeal and danger spaces in a 1-year-old girl. (a) Transverse US image shows a hypoechogenic mass (arrow) between the carotid sheath (*) and the vertebral body (VB), a finding that represents a retropharyngeal abscess. (b) Contrast-enhanced CT scan shows two heterogeneous hypoattenuating masses, one in the left retropharyngeal space with peripheral rim enhancement (arrow), and the other on the midline, in the danger space (arrowhead).
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Figure 8a. Esophageal duplication cyst in a 3-week-old boy. (a) Coronal fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine shows a hypointense unilocular cyst with a slightly enhancing wall (arrow) close to the esophagus in the right retrovisceral space. (b) On an axial T2-weighted MR image, the cyst appears hyperintense (arrow).
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Figure 8b. Esophageal duplication cyst in a 3-week-old boy. (a) Coronal fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine shows a hypointense unilocular cyst with a slightly enhancing wall (arrow) close to the esophagus in the right retrovisceral space. (b) On an axial T2-weighted MR image, the cyst appears hyperintense (arrow).
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Figure 9a. Septic jugular vein thrombophlebitis (Lemierre syndrome) in a 16-year-old girl. (a, b) Contrast-enhanced CT scans show a peritonsillar abscess (arrow in a) and jugular vein thrombophlebitis with an intraluminal thrombus (arrow in b). (c) Doppler US image depicts the thrombus (arrowheads). The blood flow in the common carotid artery is clearly visible (arrow).
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Figure 9b. Septic jugular vein thrombophlebitis (Lemierre syndrome) in a 16-year-old girl. (a, b) Contrast-enhanced CT scans show a peritonsillar abscess (arrow in a) and jugular vein thrombophlebitis with an intraluminal thrombus (arrow in b). (c) Doppler US image depicts the thrombus (arrowheads). The blood flow in the common carotid artery is clearly visible (arrow).
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Figure 9c. Septic jugular vein thrombophlebitis (Lemierre syndrome) in a 16-year-old girl. (a, b) Contrast-enhanced CT scans show a peritonsillar abscess (arrow in a) and jugular vein thrombophlebitis with an intraluminal thrombus (arrow in b). (c) Doppler US image depicts the thrombus (arrowheads). The blood flow in the common carotid artery is clearly visible (arrow).
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Figure 10a. Human immunodeficiency virus parotiditis in a 7-year-old girl. Axial US images show multiple hypoechoic lymphoepithelial cysts of varying size (arrows in a) and enlarged lymph nodes (arrow in b). Dotted line and cursors indicate the greatest dimension of one such lymph node.
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Figure 10b. Human immunodeficiency virus parotiditis in a 7-year-old girl. Axial US images show multiple hypoechoic lymphoepithelial cysts of varying size (arrows in a) and enlarged lymph nodes (arrow in b). Dotted line and cursors indicate the greatest dimension of one such lymph node.
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Figure 11a. Second branchial cleft cyst in a 13-month-old boy. (a) Axial protondensity–weighted MR image shows a hyperintense mass (arrow). (b) Axial US image depicts a hypoechoic lesion containing some slightly echogenic debris (arrow). The lesion is located anterior to the vertebral body (VB) and anteromedial to the carotid sheath space (arrowhead). T = trachea.
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Figure 11b. Second branchial cleft cyst in a 13-month-old boy. (a) Axial protondensity–weighted MR image shows a hyperintense mass (arrow). (b) Axial US image depicts a hypoechoic lesion containing some slightly echogenic debris (arrow). The lesion is located anterior to the vertebral body (VB) and anteromedial to the carotid sheath space (arrowhead). T = trachea.
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Figure 12a. Thyroglossal duct cyst in a 3-year-old boy. Sagittal (a) and coronal (b) T2-weighted MR images show a hyperintense midline cystic mass of the foramen cecum (arrow).
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Figure 12b. Thyroglossal duct cyst in a 3-year-old boy. Sagittal (a) and coronal (b) T2-weighted MR images show a hyperintense midline cystic mass of the foramen cecum (arrow).
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Figure 13a. Venous malformation in a 9-year-old boy. Transverse T2-weighted MR image (a) and transverse (b), coronal (c), and sagittal (d) fat-saturated T1-weighted MR images obtained after intravenous injection of gadopentetate dimeglumine show a mass within the right masticator space (straight arrow), with associated infiltration of the superficial fasciae of the lower lip (arrowhead) and deep infiltration of the soft palate (curved arrow in a and b). The mass is hyperintense on the T2-weighted image and demonstrates bright post-contrast enhancement on the T1-weighted images.
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Figure 13b. Venous malformation in a 9-year-old boy. Transverse T2-weighted MR image (a) and transverse (b), coronal (c), and sagittal (d) fat-saturated T1-weighted MR images obtained after intravenous injection of gadopentetate dimeglumine show a mass within the right masticator space (straight arrow), with associated infiltration of the superficial fasciae of the lower lip (arrowhead) and deep infiltration of the soft palate (curved arrow in a and b). The mass is hyperintense on the T2-weighted image and demonstrates bright post-contrast enhancement on the T1-weighted images.
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Figure 13c. Venous malformation in a 9-year-old boy. Transverse T2-weighted MR image (a) and transverse (b), coronal (c), and sagittal (d) fat-saturated T1-weighted MR images obtained after intravenous injection of gadopentetate dimeglumine show a mass within the right masticator space (straight arrow), with associated infiltration of the superficial fasciae of the lower lip (arrowhead) and deep infiltration of the soft palate (curved arrow in a and b). The mass is hyperintense on the T2-weighted image and demonstrates bright post-contrast enhancement on the T1-weighted images.
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Figure 13d. Venous malformation in a 9-year-old boy. Transverse T2-weighted MR image (a) and transverse (b), coronal (c), and sagittal (d) fat-saturated T1-weighted MR images obtained after intravenous injection of gadopentetate dimeglumine show a mass within the right masticator space (straight arrow), with associated infiltration of the superficial fasciae of the lower lip (arrowhead) and deep infiltration of the soft palate (curved arrow in a and b). The mass is hyperintense on the T2-weighted image and demonstrates bright post-contrast enhancement on the T1-weighted images.
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Figure 14a. Embryonal rhabdomyosarcoma in a 3-year-old boy. Contrast-enhanced CT scans show a solid, heterogeneously hypoattenuating, partially enhancing mass of the right parapharyngeal space. The mass extends laterally toward the mandible (arrow in a) and displaces the carotid sheath space posteriorly (arrow in b).
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Figure 14b. Embryonal rhabdomyosarcoma in a 3-year-old boy. Contrast-enhanced CT scans show a solid, heterogeneously hypoattenuating, partially enhancing mass of the right parapharyngeal space. The mass extends laterally toward the mandible (arrow in a) and displaces the carotid sheath space posteriorly (arrow in b).
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Figure 15a. Lymphatic malformation in a 5-year-old girl. Coronal (a) and axial (b) T2-weighted MR images and an axial fat-saturated T1-weighted image obtained after intravenous injection of contrast material (c) show a multiloculated cystic mass in the left posterior triangle of the neck (arrow). The cysts are hyperintense on the T2-weighted images and demonstrate peripheral wall enhancement on the T1-weighted image.
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Figure 15b. Lymphatic malformation in a 5-year-old girl. Coronal (a) and axial (b) T2-weighted MR images and an axial fat-saturated T1-weighted image obtained after intravenous injection of contrast material (c) show a multiloculated cystic mass in the left posterior triangle of the neck (arrow). The cysts are hyperintense on the T2-weighted images and demonstrate peripheral wall enhancement on the T1-weighted image.
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Figure 15c. Lymphatic malformation in a 5-year-old girl. Coronal (a) and axial (b) T2-weighted MR images and an axial fat-saturated T1-weighted image obtained after intravenous injection of contrast material (c) show a multiloculated cystic mass in the left posterior triangle of the neck (arrow). The cysts are hyperintense on the T2-weighted images and demonstrate peripheral wall enhancement on the T1-weighted image.
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Figure 16a. Cervical sporadic Burkitt lymphoma in a 7-year-old boy. (a, b) Axial T1-weighted (a) and sagittal fat-saturated T2-weighted (b) MR images obtained after intravenous injection of gadopentetate dimeglumine show a contrast-enhanced mass infiltrating the right perivertebral and epidural spaces (arrow). (c) CT scan (bone window) reveals additional infiltration of the C2 vertebral body by the mass (arrow).
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Figure 16b. Cervical sporadic Burkitt lymphoma in a 7-year-old boy. (a, b) Axial T1-weighted (a) and sagittal fat-saturated T2-weighted (b) MR images obtained after intravenous injection of gadopentetate dimeglumine show a contrast-enhanced mass infiltrating the right perivertebral and epidural spaces (arrow). (c) CT scan (bone window) reveals additional infiltration of the C2 vertebral body by the mass (arrow).
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Figure 16c. Cervical sporadic Burkitt lymphoma in a 7-year-old boy. (a, b) Axial T1-weighted (a) and sagittal fat-saturated T2-weighted (b) MR images obtained after intravenous injection of gadopentetate dimeglumine show a contrast-enhanced mass infiltrating the right perivertebral and epidural spaces (arrow). (c) CT scan (bone window) reveals additional infiltration of the C2 vertebral body by the mass (arrow).
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Figure 17a. Cervical neuroblastoma in a 3-year-old boy. (a, b) Axial proton-density–weighted (a) and contrast-enhanced T1-weighted (b) MR images show an enhancing mass of the posterior perivertebral space displacing the carotid sheath space anteriorly (arrow). Note also the posterior necrotic zone of the mass (arrowhead in b). (c) Iodine 123 metaiodobenzylguanidine scintigram shows hyperactivity in the right cervical region (arrow), a finding that helps confirm the neural crest origin of the lesion.
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Figure 17b. Cervical neuroblastoma in a 3-year-old boy. (a, b) Axial proton-density–weighted (a) and contrast-enhanced T1-weighted (b) MR images show an enhancing mass of the posterior perivertebral space displacing the carotid sheath space anteriorly (arrow). Note also the posterior necrotic zone of the mass (arrowhead in b). (c) Iodine 123 metaiodobenzylguanidine scintigram shows hyperactivity in the right cervical region (arrow), a finding that helps confirm the neural crest origin of the lesion.
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Figure 17c. Cervical neuroblastoma in a 3-year-old boy. (a, b) Axial proton-density–weighted (a) and contrast-enhanced T1-weighted (b) MR images show an enhancing mass of the posterior perivertebral space displacing the carotid sheath space anteriorly (arrow). Note also the posterior necrotic zone of the mass (arrowhead in b). (c) Iodine 123 metaiodobenzylguanidine scintigram shows hyperactivity in the right cervical region (arrow), a finding that helps confirm the neural crest origin of the lesion.
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Figure 18a. Fibromatosis colli in a 1-month-old boy. (a, b) Axial (a) and sagittal (b) US images show heterogeneous diffuse enlargement of the left sternocleidomastoid muscle (arrow). Cursors indicate the dimensions of the muscle. (c, d) Comparative axial (c) and sagittal (d) US images show a normal right sternocleidomastoid muscle (*).
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Figure 18b. Fibromatosis colli in a 1-month-old boy. (a, b) Axial (a) and sagittal (b) US images show heterogeneous diffuse enlargement of the left sternocleidomastoid muscle (arrow). Cursors indicate the dimensions of the muscle. (c, d) Comparative axial (c) and sagittal (d) US images show a normal right sternocleidomastoid muscle (*).
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Figure 18c. Fibromatosis colli in a 1-month-old boy. (a, b) Axial (a) and sagittal (b) US images show heterogeneous diffuse enlargement of the left sternocleidomastoid muscle (arrow). Cursors indicate the dimensions of the muscle. (c, d) Comparative axial (c) and sagittal (d) US images show a normal right sternocleidomastoid muscle (*).
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Figure 18d. Fibromatosis colli in a 1-month-old boy. (a, b) Axial (a) and sagittal (b) US images show heterogeneous diffuse enlargement of the left sternocleidomastoid muscle (arrow). Cursors indicate the dimensions of the muscle. (c, d) Comparative axial (c) and sagittal (d) US images show a normal right sternocleidomastoid muscle (*).
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Figure 19a. Lymphadenitis and abscess in a 10-year-old boy. (a, b) Longitudinal gray-scale (a) and color Doppler (b) US images show a homogeneously hypoechoic, rounded mass (* in a) with increased internal vascularity (arrow in b). (c) Axial fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine depicts a hypointense mass of the posterior cervical space with rim enhancement (arrow). There is also bright enhancement of the cervical muscles, a finding that is related to secondary myositis.
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Figure 19b. Lymphadenitis and abscess in a 10-year-old boy. (a, b) Longitudinal gray-scale (a) and color Doppler (b) US images show a homogeneously hypoechoic, rounded mass (* in a) with increased internal vascularity (arrow in b). (c) Axial fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine depicts a hypointense mass of the posterior cervical space with rim enhancement (arrow). There is also bright enhancement of the cervical muscles, a finding that is related to secondary myositis.
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Figure 19c. Lymphadenitis and abscess in a 10-year-old boy. (a, b) Longitudinal gray-scale (a) and color Doppler (b) US images show a homogeneously hypoechoic, rounded mass (* in a) with increased internal vascularity (arrow in b). (c) Axial fat-saturated T1-weighted MR image obtained after intravenous injection of gadopentetate dimeglumine depicts a hypointense mass of the posterior cervical space with rim enhancement (arrow). There is also bright enhancement of the cervical muscles, a finding that is related to secondary myositis.
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Copyright © 2005 by the Radiological Society of North America.
