Presentation
Left neck swelling extending to the face and anterior chest.
Patient Data
CT neck with contrast demonstrates extensive phlegmon in markedly expanded left parotid space with locules of gas and peripherally enhancing fluid collections within deep lobe of left parotid gland. Fluid is seen to tract inferiorly along anterior margin of left sternocleidomastoid muscle. A large sinus tract is seen extending from parotid space to overlying skin.
There is extension of abscess into markedly expanded left sternocleidomastoid tracking inferiorly in the intermuscular plane to clavicular insertion of muscle.
Multiple enlarged lymph nodes with the left submandibular compartments and internal jugular chain.
Compression of left internal jugular vein with subluxation of left temporomandibular joint. No mastoiditis, or evidence of dental abscess formation. No bony destruction.
Case Discussion
The patient presented to the emergency department with fever and an extensive left neck swelling. Admission bloods demonstrated a white cell count (WCC) of 17.3 and CRP of 280. Pus aspirated from left parotid gland was cultured and grew Streptococcus milleri group. Patient was treated with intravenous antibiotics and discharged home a week following admission with normal WCC and CRP.
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