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Benefits
of
ultrasound
vs.
computed
tomography
in
the
diagnosis
of
pediatric
lateral
neck
abscesses
§
Benjamin
Collins
a
,
Julie
A.
Stoner
b
, G.
Paul Digoy
a
,
*
a
Department
of Otorhinolaryngology, University
of Oklahoma Health
Sciences
Center,
P.O.
Box
26901 WP
1290, Oklahoma
City, OK
73126-0901,
United
States
b
Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 800 NE 13th Street, Oklahoma City, OK 73190, United States
1. Introduction
Lateral
neck
abscesses
are
increasing
in
incidence
in
the
pediatric
population
[1]
.
Ultrasound
and
computed
tomography
(CT)
are
currently
used
to
screen
patients
for
the
presence
or
absence
of
a
lateral
neck
abscess. While
there
have
been
some
evaluations
of
ultrasound
and
CT
in
the
literature,
there
is
no
standard
protocol
at
our
institution
and many
others.
A
recent
examination of 36 patients ages 2–62 years undergoing ultrasound
prior
to
attempted
drainage
of
an
abscess
demonstrated
96%
sensitivity
and
82%
specificity.
Positive
predictive
value was
92%
and
negative
predictive
value was
90%
[2]
.
These
are
promising
results, but
the application
to pediatric neck abscesses
is
limited by
the wide variability
in the ages of subjects
included
in this study. A
retrospective
ultrasound
study
of
41
surgically
confirmed
pediatric
neck
abscesses
revealed
31
true
positive
cases,
6
reported
as
probable
for
an
abscess,
and
4
false negative
results.
CT was positive
for an abscess on 4/5 children prior
to a surgically
confirmed
abscess
[3]
.
The major
limitation
is
that
only
children
with abscess confirmed on drainage were
included. There were no
false
positives
or
true
negatives
to
report.
These
patients
had
widely
variable
pathology
including
odontogenic,
otogenic,
and
tonsillogenic
sources,
one
following
an
insect
bite,
and
another
associated with
tuberculosis.
The majority
of
infectious
sources
were unknown. Another pediatric
study
showed
a
relatively
low
sensitivity
of
ultrasound
(65%)
but
a
high
specificity
(88%),
a
positive
predictive
value
of
81%,
a
negative
predictive
value
of
77%,
and
concluded
that
a
clinical
evaluation
is
integral
in
the
diagnosis
alongside
the
use
of
ultrasound
[4]
.
The
specific
locations of
the neck masses were not provided. The
sensitivities
and
specificities
in
these
three
ultrasound
studies
were
not
comparable
to
those
of
CT.
In
a
study
of 38
children
and
adults with deep neck
infections,
CT
has
been
shown
to
have
a
sensitivity
of
88%
in
diagnosing
an
International Journal of Pediatric Otorhinolaryngology 78 (2014) 423–426A
R
T
I
C
L
E
I
N
F
O
Article
history:
Received
7
September
2013
Received
in
revised
form
27 November
2013
Accepted
28 November
2013
Available
online
7 December
2013
Keywords:
Ultrasound
Computed
tomography
Lateral
neck
abscess
Pediatrics
A
B
S
T
R
A
C
T
Objective:
There
are no
studies
comparing
the accuracy of ultrasound
and
computed
tomography
in
the
same population of pediatric patients with
lateral neck abscesses. This
case
series assesses
the accuracy
of
the
two
imaging
techniques.
Methods:
One hundred and
forty
imaging
studies
(ultrasound
n
= 39 or CT
n
= 101)
that were performed
from
2005
to
2011
prior
to
incision
and
drainage
of
a
lateral
neck mass
at
a
tertiary
care
academic
institution were retrospectively
reviewed. All children 0–18 years of age with
lateral neck abscesses who
underwent
CT
or
ultrasound
imaging
prior
to
drainage
were
included.
Sensitivity,
specificity,
and
positive
and negative predictive
values of ultrasound
and CT were determined
as
compared
to
the gold
standard,
incision
and
drainage
of
the
suspected
abscess.
Results:
In children undergoing
incision and drainage,
the prevalence of an abscess was 89%. Ultrasound
has a high
specificity
(100%) but a
low sensitivity
(53%). The positive predictive value
(96%)
is high while
the negative predictive value
is
low
(16%), assuming a positive abscess prevalence of 0.9.
In
contrast, CT
has
low
specificity
(18%)
but
slightly
higher
sensitivity
(68%)
compared
to
ultrasound.
Similar
to
ultrasound,
CT
had
low
negative
(6%)
and
high
positive
(88%)
predictive
values.
Conclusions:
This
study
demonstrates
that
ultrasound
may
be
an
equivalently
sensitive
and
more
specific diagnostic
tool when
compared
to CT
in
the work-up
of
lateral neck
abscesses
in
children.
It
is
safe
and
effective
in
diagnosis when
there
is
an
undetermined
probability
of
an
abscess.
2013
Elsevier
Ireland
Ltd.
All
rights
reserved.
§
Presented
at
2013
Triological
Society
Combined
Sections Meeting,
Scottsdale,
AZ, United
States,
January
26,
2013.
* Corresponding
author
at:
Oklahoma
University
Health
Sciences,
Center
Department
of
ORL,
P.O.
Box
26901 WP
1290,
Oklahoma
City,
OK
73126-0901,
United
States.
Tel.:
+1
405
271
8001x47900;
fax:
+1
405
271
3248.
addresses:
benjamin-collins@ouhsc.edu(B.
Collins),
julie-stoner@ouhsc.edu(J.A.
Stoner),
paul-digoy@ouhsc.edu(G.P. Digoy).
Contents
lists
available
at
ScienceDirectInternational
Journal
of
Pediatric Otorhinolaryngology
jour nal
homepage:
www.elsevier .com/locat e/ijpo r l0165-5876/$
–
see
front matter
2013
Elsevier
Ireland
Ltd. All
rights
reserved.
http://dx.doi.org/10.1016/j.ijporl.2013.11.034Reprinted by permission of Int J Pediatr Otorhinolaryngol. 2014; 78(3):423-426.
216