Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings

BACKGROUND AND PURPOSE: Infections caused by nontuberculous mycobacteria (N TM) commonly manifest as cervicofacial adenitis in otherwise healthy childr en, The aim of this study was to characterize the imaging findings of NTM i nfection of the head and neck in immunocompetent children. METHODS: The medical records and imaging examinations (CT in 10, MR in two) were reviewed in 12 immunocompetent children with NTM infection of the hea d and neck. RESULTS: The usual presentation (n = 9) was of an enlarging, non-tender mas s with violaceous skin discoloration, unresponsive to conventional antibiot ics. The duration of symptoms was 6 days to 5 months. Imaging revealed asym metric adenopathy with contiguous low-density ring-enhancing masses in all patients, There was cutaneous extension in 10 patients, Inflammatory strand ing of the subcutaneous fat was minimal (n = 9) or absent (n = 2) in 11 pat ients, The masses involved the submandibular space (n = 3), the parotid spa ce (n = 2), the cheek (n = 1), the anterior triangle of the neck (n = 2), t he submandibular and parotid spaces (n = 2), the parotid space and neck (n = 1), and the neck and retropharyngeal space (n = 1), Surgical management i ncluded incision and drainage only (n = 2), incision and drainage,vith cure ttage (n = 2), excisional biopsy after incision and drainage (n = 1), excis ional biopsy only (n = 5), superficial parotidectomy only (n = 1), and supe rficial parotidectomy with contralateral excisional biopsy (n = 1). All pat ients improved in response to surgery and long-term antimycobacterial antib iotics. CONCLUSION: NTM infection of the head and neck has a characteristic clinica l presentation and imaging appearance, Recognition of this disease is impor tant; appropriate treatment is excision and, in selected cases, antimycobac terial therapy.