Management of Deep Neck Infections
Immediate Risk Stratification
- The American College of Radiology recommends urgent evaluation for deep neck infection with immediate imaging (CT neck with contrast) and empiric broad-spectrum antibiotics in patients with anterior neck swelling and fever, as this condition can rapidly progress to airway compromise, mediastinitis, or sepsis 1, 2
- Fever with neck swelling suggests an infectious process rather than a neoplastic one, according to the American College of Radiology and Praxis Medical Insights 1, 2
Initial Assessment and Workup
- The American Academy of Otolaryngology-Head and Neck Surgery recommends assessing vital signs, including temperature, blood pressure, heart rate, respiratory rate, and oxygen saturation, to identify sepsis or impending airway compromise 3
- A neck examination should document size, location, consistency, mobility, and presence of overlying skin changes, as recommended by the American Academy of Otolaryngology-Head and Neck Surgery and Praxis Medical Insights 2, 4
- Inflammatory markers, such as elevated ESR and C-reactive protein, support an infectious etiology, according to the American College of Radiology 1
Mandatory Imaging
- The American College of Radiology recommends CT neck with IV contrast as the gold standard for imaging, which can detect early bone changes, osteolysis, and endplate irregularities, and identify peripherally enhancing collections indicating abscess formation 1, 2
Empiric Antibiotic Therapy
- The American College of Radiology and Praxis Medical Insights recommend initiating broad-spectrum IV antibiotics covering Streptococcus viridans, Klebsiella pneumoniae, Staphylococcus aureus, and oral anaerobes while awaiting imaging results 1, 2