Recurrence of a deep neck infection - A clinical indication of an underlying congenital lesion

Objective: To discuss the computed tomographic (CT) and clinical findings o f those entities that may present as recurrent deep neck infections. Patients and Methods: Twelve patients with recurrent deep neck infections a nd CT scans were retrospectively identified since 1990. Their CT scans and medical histories were reviewed. The diagnosis was pathologically confirmed in all cases. Results: The CT scans revealed an abscess or a localized infected cyst in t he deep soft tissues of the neck, with varying degrees of associated inflam matory change in the adjacent soft tissues. The diagnoses in these cases in cluded 1 first branchial cleft cyst, 3 second branchial cleft cysts, 1 thir d branchial cleft cyst, 2 fourth branchial cleft cysts, 2 infected lymphang iomas, 2 thyroglossal duct cysts, and 1 cervical thymic cyst. Conclusions: Most deep neck infections are the result of suppurative adenit is. The location of the primary focus is usually from the mucosa of the upp er aerodigestive tract or from an odontogenic source. Less common causes ar e perforations due to a foreign body, thrombophlebitis of the internal jugu lar vein, or osteomyelitis of the spine. Recurrences in these situations ar e unusual. Less commonly, congenital lesions can present as deep neck infec tions, and recurrences are common. Our cases suggest that the recurrence of a deep neck infection should alert the physician to the possibility of an underlying congenital lesion and that CT is helpful in the early recognitio n of these lesions.