Neuroradiologie Scan 2011; 1(1): 33-54
DOI: 10.1055/s-0030-1256796
Fortbildung

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostische Bildgebung bei Kopf- und Halserkrankungen in der pädiatrischen Notfallmedizin

Diagnostic imaging in nontraumatic pediatric head and neck emergencies[1] B.  J.  Ludwig, B.  R.  Foster, N.  Saito, R.  N.  Nadgir, I.  Castro-Aragon, O.  Sakai
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Publikationsverlauf

Publikationsdatum:
19. September 2011 (online)

Zusammenfassung

Eine Beurteilung pädiatrischer Notfälle wird in der Regel durch eine begrenzte Vorgeschichte und die eingeschränkte körperliche Untersuchung erschwert, wodurch es häufig zu überlappenden Befunden mit verschiedenen Krankheitsprozessen kommt. Für eine exakte und frühzeitige Diagnostik ist die Bildgebung somit von entscheidender Bedeutung. Eine Kenntnis der typischen klinischen und radiologischen Manifestationen verbreiteter pädiatrischer Notfälle des Kopf- und Halsbereichs sowie angeborener Fehlbildungen erlaubt dem untersuchenden Radiologen die Identifizierung der primären Ursache der Erkrankung und der damit in Verbindung stehenden Komplikationen, was wiederum eine sofortige operative Behandlung ermöglichen könnte. Das Bildgebungsprotokoll des einzelnen Patienten hängt dabei jeweils von seinem aktuellen klinischen Zustand ab. Für die Erstuntersuchung kommen Übersichtsaufnahmen, Ultraschall und kontrastmittelverstärkte Computertomografie (CT) infrage. Bei besonders komplexen Fällen könnte eine Magnetresonanztomografie (MRT) weiteren Aufschluss über das Ausmaß der Erkrankung geben.

Abstract

Evaluation of pediatric patients in the emergency setting is complicated by a limited history and physical examination, which often produce findings that overlap with multiple disease processes. Imaging therefore plays a critical role in achieving an accurate and timely diagnosis. Knowledge of the typical clinical and imaging manifestations of common pediatric head and neck emergencies and congenital abnormalities allows the interpreting radiologist to identify the primary cause of the condition as well as any associated complications that may warrant immediate surgical management. The specific imaging protocol depends on the patient’s clinical status. Radiography, ultrasonography, and contrast material-enhanced computed tomography all may be appropriate modalities for an initial examination. In especially difficult or complex cases, magnetic resonance imaging may offer additional detail with respect to the extent of disease.

1 © 2011 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2010; 30: 781 – 799. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

Literatur

  • 1 Mafee M F. Orbit: embryology, anatomy, and pathology.. In: Som P M, Curtin H D,, eds Head and neck imaging.. 4th ed. St. Louis, Mo: Mosby; 2003: 529-654
  • 2 LeBedis C A, Sakai O. Nontraumatic orbital conditions: diagnosis with CT and MR imaging in the emergent setting.  RadioGraphics. 2008;  28 1741-1753
  • 3 Eustis H S, Mafee M F, Walton C et al. MR imaging and CT of orbital infections and complications in acute rhinosinusitis.  Radiol Clin North Am. 1998;  36 1165-1183
  • 4 Fakhri S, Pereira K. Endoscopic management of orbital abscesses.  Otolaryngol Clin North Am. 2006;  39 1037-1047
  • 5 Kassel E E, Schatz C J. Lacrimal apparatus.. In: Som P M, Curtin H D,, eds Head and neck imaging.. 4th ed. St. Louis, Mo: Mosby; 2003: 655-733
  • 6 Kronemer K A, McAlister W H. Sinusitis and its imaging in the pediatric population.  Pediatr Radiol. 1997;  27 837-846
  • 7 American College of Radiology .ACR Appropriateness Criteria: sinusitis – child. Im Internet: http://http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonPediatricImaging/SinusitisChildDoc8.aspx Stand: 05.07.2011
  • 8 Epstein V A, Kern R C. Invasive fungal sinusitis and complications of rhinosinusitis.  Otolaryngol Clin North Am. 2008;  41 497-524
  • 9 Morón F E, Morriss M C, Jones J J et al. Lumps and bumps on the head in children: use of CT and MR imaging in solving the clinical diagnostic dilemma.  RadioGraphics. 2004;  24 1655-1674
  • 10 Khanna G, Sato Y, Smith R J et al. Causes of facial swelling in pediatric patients: correlation of clinical and radiologic findings.  RadioGraphics. 2006;  26 157-171
  • 11 Department of Health and Human Services .Guide to children’s dental care in Medicaid. Im Internet: http://http://www.cms.hhs.gov/medicaiddentalcoverage/downloads/dentalguide.pdf (veröffentlicht 10/2004; Stand: 05.07.2011)
  • 12 Ladrillo T E, Hobdell M H, Caviness A C. Increasing prevalence of emergency department visits for pediatric dental care, 1997 – 2001.  J Am Dent Assoc. 2006;  137 379-385
  • 13 Dunfee B L, Sakai O, Pistey R et al. Radiologic and pathologic characteristics of benign and malignant lesions of the mandible.  RadioGraphics. 2006;  26 1751-1768
  • 14 Vieira F, Allen S M, Stocks R M et al. Deep neck infection.  Otolaryngol Clin North Am. 2008;  41 459-483
  • 15 Marcus B J, Kaplan J, Collins K A. A case of Ludwig angina: a case report and review of the literature.  Am J Forensic Med Pathol. 2008;  29 255-259
  • 16 Smoker W RK. The oral cavity.. In: Som P M, Curtin H D,, eds Head and neck imaging.. 4th ed. St. Louis, Mo: Mosby; 2003: 1377-1464
  • 17 Britt J C, Josephson G D, Gross C W. Ludwig’s angina in the pediatric population: report of a case and review of the literature.  Int J Pediatr Otorhinolaryngol. 2000;  52 79-87
  • 18 Laine F J, Nadel L, Braun I F. CT and MR imaging of the central skull base. II. Pathologic spectrum.  RadioGraphics. 1990;  10 797-821
  • 19 Robson C, Hudgins P. Pediatric airway disease.. In: Som P M, Curtin H D,, eds Head and neck imaging.. 4th ed. St. Louis, Mo: Mosby; 2003: 1521-1594
  • 20 Danesi G, Panciera D T, Harvey R J et al. Juvenile nasopharyngeal angiofibroma: evaluation and surgical management of advanced disease.  Otolaryngol Head Neck Surg. 2008;  138 581-586
  • 21 Wiatrak B J, Koopmann C F, Turrisi A T. Radiation therapy as an alternative to surgery in the management of intracranial juvenile nasopharyngeal angiofibroma.  Int J Pediatr Otorhinolaryngol. 1993;  28 51-61
  • 22 Vazquez E, Castellote A, Piqueras J et al. Imaging of complications of acute mastoiditis in children.  RadioGraphics. 2003;  23 359-372
  • 23 Grandis J R, Curtin H D, Yu V L. Necrotizing (malignant) external otitis: prospective comparison of CT and MR imaging in diagnosis and follow-up.  Radiology. 1995;  196 499-504
  • 24 Wiggins R. Necrotizing external otitis.. In: Harnsberger R, Hudgins P, Wiggins R, et al, eds Diagnostic imaging: head and neck.. Salt Lake City, Utah: Amirsys; 2004; 10-13
  • 25 Carfrae M J, Kesser B W. Malignant otitis externa.  Otolaryngol Clin North Am. 2008;  41 537-549
  • 26 Sobol S E, Zapata S. Epiglottitis and croup.  Otolaryngol Clin North Am. 2008;  41 551-566
  • 27 Donnelly L F. Airway.. In: Donnelly L F,, ed Pediatric imaging: the fundamentals.. Philadelphia, Pa: Saunders; 2009: 8-25
  • 28 Digoy G P. Diagnosis and management of upper aerodigestive tract foreign bodies.  Otolaryngol Clin North Am. 2008;  41 485-496
  • 29 Herzon F S. Peritonsillar abscess: incidence, current management practices, and a proposal for treatment guidelines. Harris P. Mosher Award thesis.  Laryngoscope. 1995;  105 (Suppl. 74) 1-17
  • 30 Koeller K K, Alamo L, Adair C F et al. Congenital cystic masses of the neck: radiologic-pathologic correlation.  RadioGraphics. 1999;  19 121-146
  • 31 Kutuya N, Kurosaki Y. Sonographic assessment of thyroglossal duct cysts in children.  J Ultrasound Med. 2008;  27 1211-1219
  • 32 Thomas B, Shroff M, Forte S et al. Revisiting imaging features and the embryologic basis of third and fourth branchial anomalies.  Am J Neuroradiol. 2009;  DOI: DOI: 10.3174/ajnr.A1902
  • 33 Park S W, Han M H, Sung M H et al. Neck infection associated with pyriform sinus fistula: imaging findings.  AJNR Am J Neuroradiol. 2000;  21 817-822
  • 34 Sakai O, Curtin H D, Romo L V et al. Lymph node pathology: benign proliferative, lymphoma, and metastatic disease.  Radiol Clin North Am. 2000;  38 979-998
  • 35 Ahuja A T, Ying M. Sonographic evaluation of cervical lymph nodes.  AJR Am J Roentgenol. 2005;  184 1691-1699
  • 36 Craig F W, Schunk J E. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management.  Pediatrics. 2003;  111 1394-1398
  • 37 Delman B N, Weissman J L, Som P M. Skin and soft-tissue lesions.. In: Som P M, Curtin H D,, eds Head and neck imaging.. 4th ed. St. Louis, Mo: Mosby; 2003: 2173-2215
  • 38 Barkovich A J. Intracranial, orbital, and neck masses of childhood.. In: Barkovich A J,, ed Pediatric neuroimaging.. 4th ed. Philadelphia, Pa: Lippincott, Williams, and Wilkins; 2005: 506-658

1 © 2011 The Radiological Society of North America. All rights reserved. Originally published in English in RadioGraphics 2010; 30: 781 – 799. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

Benjamin J. LudwigMD 

Department of Radiology
Boston University Medical Center
Boston University School of Medicine

820 Harrison Ave
FGH Bldg., 3rd Floor
Boston, MA 02118
USA

eMail: benjamin.ludwig@bmc.org

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