Cervical Lymphadenitis, Suppurative Parotitis, Thyroiditis, and Infected Cysts

doi:10.1016/j.idc.2007.03.004

Infectious Disease Clinics of North America

Volume 21, Issue 2, June 2007, Pages 523-541

https://doi.org/10.1016/j.idc.2007.03.004 Get rights and content

Neck masses are common and have a variety of infectious agents and noninfectious causes. This article reviews the more common infectious causes of neck masses—cervical lymphadenitis, suppurative parotitis, thyroiditis, and infected cysts. Important clinical pearls, diagnostic evaluation including laboratory studies, and imaging are summarized. Methods for prevention are highlighted.

Section snippets

Cervical lymphadenitis

The cervical lymphatic system involves a great array of superficial and deep lymph nodes that protect the head, neck, nasopharynx, and oropharynx against infection. Cervical lymphadenitis is characterized by inflammation of one or more of these lymph nodes. Most cases of cervical lymphadenitis, especially in children, are caused by an infectious agent; some immunologic processes and malignancies result in a similar presentation. The following section reviews the differential diagnosis and

Suppurative parotitis

Inflammation of the parotid gland is caused by a variety of infectious agents and noninfectious systemic illnesses. Depending on the clinical presentation and cause, parotitis can be classified into several types: suppurative, viral, granulomatous, recurrent, or chronic. Determining the type of parotitis has important treatment implications.

Thyroiditis

The thyroid gland is remarkably resistant to infection, and infectious thyroiditis is quite rare. Infectious thyroiditis can be classified into three groups: (1) acute suppurative (AST); (2) subacute (ST); and (3) chronic thyroiditis. The incidence of infectious thyroiditis is unknown, but AST is estimated to account for 0.1% to 0.7% of all thyroid pathology [35], [36]. AST, first described by Bauchet in 1857, carries substantial risk and should be treated as a medical emergency. In the

Thyroglossal duct cyst

Thyroglossal duct cysts (TDC) account for 70% of congenital neck anomalies. TDC arise from the embryonic remnant of the thyroglossal duct that connects the foramen cecum (at the base of the tongue) with the thyroid gland. Most patients remain asymptomatic for years. A midline neck mass developing during late childhood, adolescence, or even adulthood is the most common presentation. There is a slight male predominance [55].

Dermoid and epidermoid cysts

Dermoid cysts and epidermoid cysts are the second most common congenital

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Acute suppurative thyroiditis progressing to a thyroid abscess; a case report with review of literature
2022, International Journal of Surgery Open
Acute suppurative thyroiditis is a rare and potentially life-threatening disease. The aim of the current study is to report a rare case of acute suppurative thyroiditis progressing to a thyroid abscess.
A 67-year-old female presented with a painful neck swelling for one week. On Ultrasound examination, right thyroid lobe was enlarged due to a complex thick-walled mass with echogenic shadow. It pushed the right common carotid artery laterally. Computed tomography showed a well-defined collection in the right thyroid lobe with an enhancing margin. The center of the lesion was necrotic and contained gas, diffuse edema around the right thyroid lobe was also evident. The patient underwent right thyroid lobectomy and the result of histopathology examination was thyroid abscess without malignancy.
The clinical spectrum of acute suppurative thyroiditis is broad, since asymptomatic cases have been documented. Fever and painful anterior neck mass are the two of the most common clinical manifestations. Other frequent manifestations include dysphagia, hoarseness of voice, and sore throat. The pain may radiate to the chest, mandible, or ears.
Acute suppurative thyroiditis progressing to an abscess formation is a rare but potentially life-threatening condition if left untreated.
Clinical characteristics that predict parotid abscess: An observational cohort study
2021, Annals of Medicine and Surgery
We analysed clinical factors that are predictive of a diagnosis of parotid abscess among patients with bacterial parotitis.
This retrospective study included 64 hospitalised patients who were diagnosed with parotid abscess, or bacterial parotitis. Data on patient demographics, clinical characteristics, and clinical management were collected. Predictive factors for parotid abscess were evaluated using univariate and multivariate analysis.
There were 25 patients with parotid abscess and 39 with bacterial parotitis. All patients presented with moderate-to-severe disease, required parenteral antibiotics, or had indicators for surgical drainage. Patient profiles and immune status were not significantly associated with parotid abscess. However, parameters that were significantly related to parotid abscess were subacute presentation (approximate 10.4 days) (p value = 0.016), fluctuation (p value < 0.001), and normal (haemoglobin) Hb level >12–13 g/dL (p value = 0.035). Imaging indicated the abscess location, extension and evaluated the complications. Surgical drainage with small skin incision and antibiotic coverage for possible pathogens, in particular Staphylococcus spp. and Streptococcus spp. produced favourable patient outcomes. Complication was identified in 3 cases with included septicaemia and cellulitis of the face and parapharyngeal space.
Among bacterial parotitis patients, parotid abscess should be considered in whom presented with subacute duration of symptoms, enlarged glands with fluctuation, and non-anaemic problem. Instead of standard skin incision of parotidectomy, small vertical skin incision over a well localised abscess pocket or fluctuated area achieved the good results.
Idiopathic thyroid abscess in a healthy 22-year old female – A case of anchoring bias
2021, Journal of Clinical and Translational Endocrinology: Case Reports
Thyroid abscess is a rare pathology, accounting for less than 1% of all thyroid diseases. Those who do experience thyroid abscesses are commonly immunocompromised, as the thyroid is highly resilient to infections. Here, we illustrate a case of a thyroid abscess in a young, healthy patient with no pre-existing medical conditions or anatomical abnormalities. Initial emergency department CT imaging illustrated a cystic, homogenous neck mass that was initially suspected to be a thyroid carcinoma. The patient was referred to the Department of Endocrine Surgery at a tertiary academic medical center for workup and management. On presentation to Endocrine Surgery, the patient complained of fever, progressive swelling of the mass causing an inability to move her neck, inability to eat or drink, inability to lie flat due to shortness of breath, and new-onset sialorrhea and voice changes. Bedside ultrasound and fine-needle aspiration confirmed a thyroid abscess, and the patient was emergently taken to the operating room for neck exploration, hemithyroidectomy, and incision/drainage of the thyroid abscess.
Acute suppurative thyroiditis seeded from infective endocarditis and intravenous drug use
2021, IDCases
Acute suppurative thyroiditis (AST) is a rare infection of the thyroid gland, and most patients are euthyroid upon presentation. We present an interesting case of a 42-year-old man with a history of intravenous drug use (IVDU) and poorly controlled type 2 diabetes mellitus who was admitted for sepsis and thyrotoxicosis from infective endocarditis (IE), AST, prostate abscess, and pyelonephritis. He suffered from a cerebral vascular accident (CVA) from septic embolic showering. Thyroid-stimulating hormone (TSH) was <0.10 mIU/L, and free thyroxine (T4) levels were>90 pmol/L. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured in the patient’s blood and urine. He was treated with prompt intravenous (IV) antimicrobials and source control from a transurethral resection of the prostate. This case demonstrates that AST can be a potential complication of IE and IVDU.
Suppurative cervical lymphadenitis in adult: An analysis of predictors for surgical drainage
2020, Auris Nasus Larynx
Citation Excerpt :
However, in pyogenic cases, patients require both abscess drainage and antibiotic treatment for successful outcomes [1,5]. The incidence of lymphadenitis is highest children aged of 4–8 years, which can lead to atrophy due to its physiology [1,2,5]. Therefore, previous studies have mostly focused on pediatric patients [1,2,5].
Lymphadenitis can be treated successfully by empirical antibiotic therapy. However, inflamed lymph nodes can progress into an abscess with local and/or systemic reaction, which requires more complex treatment strategies. The study aim to analyze possible predictors for abscess formation within inflamed nodes that require surgical drainage.
We retrospectively enrolled 241 patients with acute or sub-acute cervical lymphadenitis. Demographic including, lymph node characteristics, management, and final diagnosis were recorded. Predictors for abscess formation within the lymph node that required surgical drainage were evaluated using univariate and multivariate analysis. Patient and lymph node characteristics that differentiated suppurative cervical lymphadenitis (SCL) from other lymphadenitis were also analyzed.
There were 41 cases of SCL, 173 cases of uncomplicated cervical lymphadenitis, and 27 cases of tuberculous cervical lymphadenitis (TBLN). Abscess was surgically drained in 39 patients, while 2 patients received a needle aspiration. In 9 patients, SCL complications included cellulitis of the neck soft tissue, supraglottic swelling, internal jugular vein thrombosis, and sepsis. Two patients were diagnosed with melioidosis and actinomycosis after drainage. Multivariate analysis showed that an immunocompromised host, male sex, and receiving prior inadequate treatment were predictors for surgical drainage. TBLN patients had similar manifestations as SCL patients. However, affected nodes in SCL patients were singular, painful, and showed fluctuation.
Following SCL diagnosis, abscess drainage and appropriate antibiotic treatment should be considered. Aspiration or surgical drainage can be effective in certain patients. Pathogen isolation and tissue biopsy should be performed to ensure accurate diagnosis and antibiotic selection. In addition, TBLN and melioidosis should be considered, especially in endemic areas.
Predictors of a drainable suppurative adenitis among children presenting with cervical adenopathy
2019, American Journal of Emergency Medicine
We sought to identify predictors for a drainable suppurative adenitis [DSA] among patients presenting with acute cervical lymphadenitis.
A retrospective cross sectional study of all patients admitted to an urban pediatric tertiary care emergency department over a 15 year period. Otherwise healthy patients who underwent imaging for an evaluation of cervical lymphadenitis were included. Cases were identified using a text-search module followed by manual review. We excluded immunocompromised patients and those with lymphadenopathy felt to be not directly infected (i.e. reactive) or that was not acute (symptom duration >28 days). Data collected included: age, gender, duration of symptoms, highest recorded temperature, physical exam findings, laboratory and imaging results, and surgical findings. A DSA was defined as >1.5 cm in diameter on imaging. We performed binary logistic regression to determine independent clinical predictors of a DSA.
Three hundred sixty-one patients met inclusion criteria. Three hundred six patients (85%) had a CT scan, 55 (15%) had an ultrasound and 33 (9%) had both. DSA was identified in 71 (20%) patients. Clinical features independently associated with a DSA included absence of clinical pharyngitis, WBC >15,000/mm³, age ≤3 years, anterior cervical chain location, largest palpable diameter on exam >3 cm and prior antibiotic treatment of >24 h. The presence of fever, skin erythema, or fluctuance on examination, was not found to be predictive of DSA.
We identified independent predictors of DSA among children presenting with cervical adenitis. Risk can be stratified into risk groups based on these clinical features.

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Cervical Lymphadenitis, Suppurative Parotitis, Thyroiditis, and Infected Cysts

Section snippets

Cervical lymphadenitis

Suppurative parotitis

Thyroiditis

Thyroglossal duct cyst

Dermoid and epidermoid cysts

Childhood cervical lymphadenitis: a reappraisal

J Pediatr

The swollen neck. Cervical lymphadenitis, parotitis, thyroiditis, and infected cysts

Infect Dis Clin North Am

Acute suppurative adenitis in children: a review of 964 cases

Scott Med J

Group B streptococcal cellulitis-adenitis in infants

Am J Dis Child

Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk

JAMA

Community-associated methicillin-resistant Staphylococcus aureus infection among healthy newborns— Chicago and Los Angeles county, 2004

MMWR Morb Mortal Wkly Rep

Mycobacterial cervical lymphadenopathy: relation of etiologic agents to age

JAMA

Tuberculosis in the pediatric population of Houston, Texas

Pediatrics

Mycobacterial lymphadenitis in children: a prospective study of 105 nontuberculous cases with long-term follow-up

Clin Infect Dis

Cat-Scratch disease: a bacterial infection

Science

Survival in children with perinatally acquired human immunodeficiency virus type 1 infection

N Engl J Med

1993 Revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults

MMWR Morb Mortal Wkly Rep

Global epidemic of human T-cell lymphotropic virus type-1 (HTLV-1)

J Emerg Med

Etiology of cervical lymphadenitis in children

N Engl J Med

The aetiology of acute cervical adenitis in children: serological and bacteriological studies

J Med Microbiol

The expanding spectrum of Bartonella infection. II. Cat-scratch disease

Pediatr Infect Dis J

Hepatosplenic cat-scratch disease in children: selected clinical features and treatment

Clin Infect Dis

High-resolution and color Doppler ultrasonography of cervical lymphadenopathy in children

Acta Radiol

Prospective randomized double blind placebo-controlled evaluation of azithromycin for treatment of cat-scratch disease

Pediatr Infect Dis J

Diagnosis and treatment of disease caused by nontuberculosis mycobacteria

Am J Respir Crit Care Med

Staphylococcal parotitis

N Engl J Med

Acute suppurative parotitis: a study of 161 cases

Ann Surg

Suppurative parotitis in children

Oral Surg Oral Med Oral Pathol

Aerobic and anaerobic microbiology of acute suppurative parotitis

Laryngoscope

Microbiology of recurrent parotitis

Pediatr Infect Dis J

Mycobacterial infection of the parotid gland: an unusual case of parotid swelling

J Laryngol Otol

Actinomycosis of the parotid gland

Br J Oral Maxillofac Surg

Exanthem and enanthem associated with mumps virus infection

Arch Environ Health

Parotitis

Recurrent parotitis and sialectasis in childhood: clinical, radiologic, immunologic, bacteriologic, and histologic study

Ann Otol Rhinol Laryngol

Parotid disease associated with human immunodeficiency virus infection

Ear Nose Throat J