Imaging

Suppurative Lymphadenitis

Preliminary Diagnosis: Suppurative lymphadenitis

I. What imaging technique is first-line for this diagnosis

  • CT soft tissue neck with IV contrast is the first-line imaging modality (given that the location of interest of lymphadenitis is the neck.)

II. Describe the advantages and disadvantages of this technique for diagnosis of suppurative lymphadenitis.

Advantages

  • Highly sensitive and specific imaging modality in detecting and detailing the location and extent of suppurative lymph nodes.

  • Offers exquisite detail of the structures of the neck and is able to differentiate vascular structures, lymph nodes, musculature, and osseous structures with great specificity.

  • Better adept than other imaging modalities in detailing any secondary complications

  • May help guide treatment.

Disadvantages

  • Exposes patients to ionizing radiation.

III. What are the contraindications for the first-line imaging technique?

  • May be contraindicated in pregnant patients.

IV. What alternative imaging techniques are available?

  • MR of the neck with IV contrast

  • Ultrasound

V. Describe the advantages and disadvantages of the alternative techniques for diagnosis of suppurative lymphadenitis.

MR of the neck with IV contrast

Advantages

  • Does not expose patients to ionizing radiation.

Disadvantages

  • Expensive

  • Time-consuming

  • Less adept in localizing the primary suppurative lymph nodes and extensions compared with CT imaging.

  • Offers less exquisite evaluation of the surrounding osseous structures.

  • May be subject to motion artifact due to length of exam and susceptibility-weighted artifact degrading image quality.

Ultrasound

Advantages

  • More portable than MR and CT imaging

  • Less expensive than companion CT and MR imaging.

  • May help guide treatment.

Disadvantages

  • Operator-dependent.

  • Sonographic waves are not able to penetrate through bone and air, and are better able to evaluate superficial structures.

VI. What are the contraindications for the alternative imaging techniques?

MR of the neck with IV contrast

  • Contraindicated in patients with non-MR compatible hardware.

  • Relative contraindication in patients with renal failure

Ultrasound

  • No specific contraindications exist.

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