Abstract

Introduction: Neck masses can be of diverse etiology and origin and usually pose a diagnostic challenge to treating surgeon or physician. A patient with neck mass almost always is referred for imaging; a very close and compact arrangement of vital structures, coupled with complex deposition of deep cervical fascia (DCF) makes neck imaging difficult even for general radiologist. Ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) can all be used in non invasive assessment of neck lesions. While ultrasound can provide important information about superficial lesions like those affecting the thyroid and neck vessels, it has got limited spatial resolution moreover it is operator dependant. It is also poor is characterizing lesion of deep spaces of neck. MRI is extremely useful in assessment of neck lesions due to its excellent soft tissue delineation and multiplaner imaging capabilities but is limited by its availability and cost. Moreover it requires patient to remain still for a longer duration which sometimes is not possible in painful neck masses and may require sedation in paediatric patients. Because of these drawbacks associated with ultrasound and MRI, CT has emerged as an important modality for diagnosis of neck lesions. Various neck masses which can reliably be diagnosed on computed tomography include congenital and developmental masses, infections, neoplastic diseases and vascular masses. This study was conducted to study the utility of computed tomography in above mentioned neck masses. 

Aims and Objectives:  To study the use of spiral Computed tomography and multidimensional reformations for detection and characterization of various neck masses i.e. congenital and developmental neck masses, infections, neoplastic and vascular masses. 

Materials and Methods: This was a prospective cohort study consisting of 117 patients who presented with neck masses conducted at a tertiary care medical hospital in an urban area. The patients having history suggestive of neck mass like hoarseness of voice, palpable lesion in neck, mass seen on indirect laryngoscopy and neck survey revealing neck mass of unknown etiology were included in this study. The patients were kept NBM at least for 4 hours before doing CT scan. CT neck with contrast was done according to a pre-defined protocol. Multiplaner reconstructions were performed whenever applicable. The images were reviewed and studied with special consideration to the purpose of the study.

Results: Total 117 patients with neck masses who met the criteria of the study were included in this study. There were 69 males (58.97%) and 48 females (41.03%) with a male to female ratio of 1:0.69. Most common etiology of neck mass was found to be infections (17.9%) followed by ca larynx (14.5%) and swellings involving thyroid gland (11.1%). Least common causes were found to be schwannoma, laryngeal papillomatosis, tracheal tumours, brachial cysts, lipoma of neck and pleomorphic adenoma of submandibular gland which were seen in 0.85% each. The study of infectious lesions revealed that the most common space involved in infections was submandibular space which were seen in 12/21 (57.14%) patients followed by retropharyngeal (23.81%) and pre vertebral spaces (9.52%). Carcinoma larynx and hypopharynx was found to be most common in the age group of 61-70 years (12/17) and was more common in males. It was not seen in patients below 30 years or above 70 years of age in our study. While the most common site of laryngeal carcinoma was found to be supraglottic region (14/17) followed by glottic (2/17) and transglottic regions (1/17), hypopharyngeal carcinoma was most commonly seen in the region of pyriform fossa (9/12). Neoplastic lesions of neck were found to be associated with lymphadenopathy involving level I -IV. The most common pathology seen in swellings involving thyroid gland was multi nodular goiter (9/13) followed by anaplastic carcinoma (3/13) and papillary carcinoma (1/13). Most common pathology involving parotid was chronic pancreatitis which was seen in 2 patients. Other causes of neck swellings found in our study included neoplastic diseases (ca-buccal mucosa, tonsil, cervical esophagus and nasopharynx), ranula, parathyroid diseases, lymohangioma, haemangioma and lymphadenopathy.

Conclusion: Though in recent years MR imaging is considered to be imaging modality of choice for neck masses computed tomography is extremely useful in defining bony involvement and soft tissue extent of the lesion. It is fast, widely available and suitable for even patients in whom MRI may be contraindicated.    

Keywords: Neck swellings, Computed Tomography, Staging of tumour, Lymphadenopathy.