Male, 39 years old, with rapidly growing left neck mass. Dog bite one month ago. Extensive edema is evident within the left neck involving the parotid space, masticator space, submandibular space, sublingual space and floor of mouth, retropharyngeal and pharyngeal spaces. The left-sided submandibular gland is particularly edematous. There is mass effect on the airway with mild effacement and slight rightward deviation. Inflammation appears to track through the submental soft tissues to involve the right neck to a lesser degree than the left.Although there may be tracking fluid within the retropharyngeal space, no definite evidence of a discrete or loculated fluid collection is seen allowing for the absence of IV contrast. On diffusion-weighted images, multiple diffusion restricting lymph nodes are seen which is compatible with inflammation, but no discrete fluid collections are demonstrated.Mild edema is seen within the left ventricular body. Elsewhere, marrow signal characteristics are unremarkable.A right pleural effusion is partially visualized. The vascular flow voids of the visualized neck vessels appear to be preserved compatible with patency.
Extensive cellulitis involving the left neck more than the right including superficial and deep spaces. There is mass effect with partial effacement and rightward deviation of the airway.There may be tracking fluid within the retropharyngeal space, but no definite evidence of a discrete or loculated abscess collection is seen. Although the absence of IV contrast does limit evaluation for abscess, diffusion-weighted imaging at least partially makes up for this shortcoming, and there is no diffusion evidence of an abscess at this time.Marrow edema is seen within the left mandibular body which could represent contiguous inflammation or infection.