Evaluation of the neck with computed tomography in the emergency setting

Objectives: Retrospective analysis of Computed tomography (CT) role in the Neck soft tissue pathologies in emergency set- ting and correlation with clinical and laboratory data. Materials and Methods: In retrospective study 208 patients presenting to emergency department with neck soft tissue pathologies were enrolled within 2 year period, all of which received Neck CT examination with or without contrast enhance- ment. Post-contrast examination up to 3 series was performed, depending on the initial diagnosis (trauma, inflammation or oncology).
Results: Neck soft tissue pathology was found in 175 of all cases - 105 inflammatory, 54 oncology and 19 cases of other pathology. Pharyngealmucosalspacewasinvolvedinmostcases(n=100),parapharyngealspace(n=81),parotid space(n=28), masticator space(n=21). Outofallhistologicallyexaminedtumours,mostcommonwaslaryngealtumour(n=15),palatinetonsiltu- mour(n=10), basis of the tongue tumour(n=9).
Non-specific, reactive, enlarged lymph nodes were found in 90 cases and specific oncology related histologically proven lymph nodes in 18 cases out of 108 cases of lymphadenopathy. C reactive protein(CRP) values were higher in abscess cases (Me=125 mg/l) than in trauma(Me=15 mg/l) or tu- mour(Me=46.36 mg/l), p<0.05.
Defining anatomical localization of the pathology in the interfascial spaces is important, but it does not narrow the radiological differential diagnosis (p>0.05).
Conclusions: Neck CT examination is available and effective at the emergency department for early diagnosis of the type of pathology, prevalence, complications and subsequent planning of treatment tactics.
For evaluation of soft cervical tissues in patients with clinical suspicion of oncology, adjustable extended 3-series CT test protocol is advised to accurately assess the extension and vascularization characteristics, in other cases non-enhanced and late phase 100th second CT scan after contrast administration should be performed, according to the standardized protocol - to reduce the radiation dose for the patient. CRP level is essential for the choice of best suitable imaging CT protocol.