Presentation
1 week left submandibular swelling, progressed on oral antibiotics. On treatment for Crohn disease.
Patient Data
Multiloculated 2.5 cm fluid collection with peripheral enhancement in the left submandibular space. No gas within the collection. The gland is medially and inferiorly displaced. The left submandibular gland enhances normally, with minor duct dilatation (no filling defect).
Left parapharyngeal stranding and swelling, but no collection here or in other deep spaces. No spread into the carotid canal or mediastinum. Local nodal enlargement, none reaching size significance. Normal left parotid. Tiny left thyroid nodule. The right side of the neck is normal.
No airway compromise.
Case Discussion
Suppurative lymphadenitis in the left submandibular space. Local reactive change but no deeper collection. Possible submandibular sialadenitis.
The patient was immunosuppressed on a monoclonal antibody treatment for Crohn disease.
The collection was aspirated under ultrasound guidance, with Staphylococcus aureus cultured.
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