Nontuberculous Mycobacterial Infection of the Head and Neck in Immunocompetent Children: CT and MR Findings
Caroline D. Robson,a,
Rohan Hazraa,
Patrick D. Barnesa,
Richard L. Robertsona,
Dwight Jonesa and
Robert N. Hussona
a From the Department of Radiology (C.D.R., P.D.B., R.L.R.),the Division of Infectious Diseases, (R.H., R.N.H.), and the Department of Otolaryngology (D.J.), Children's Hospital and Harvard Medical School, Boston, MA.
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FIG 1. Case 1: Girl, 2 years six months old, with nontender right submandibular mass. Axial contrast-enhanced CT scan shows medial displacement of right submandibular gland (S) by right submandibular adenopathy (A). Suppurative granulomatous material represented by low-density ring-enhancing subcutaneous mass (arrow) extending from adenopathy to skin. Minimal stranding of adjacent subcutaneous fat is present.
FIG 2. Case 7: Four-year-old girl with masses in left preauricular and submandibular regions. Axial contrast-enhanced fat-suppressed T1-weighted, 700/16/2 (TR/TE/excitations), conventional spin-echo MR image, demonstrates low signal intensity lesion (arrow) with ring enhancement, which corresponded to purulent material at surgery. Mass extends from superficial surface of left intraparotid lymph node (short arrow) to skin. No stranding of the adjacent subcutaneous fat is present.
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FIG 3. Case 8: Girl, two years six months old, with 4-week history of enlarging left posterior triangle neck mass and deviation of oropharynx to right. Axial contrast-enhanced CT scan shows low-density ring-enhancing spinal accessory adenopathy (short arrow) with extension to skin. Enlarged low-density ring-enhancing left retropharyngeal adenopathy (long arrow) causing distortion and narrowing of oropharynx is present.
FIG 4. Case 10: Girl, two years nine months old, with right parotid and right cervical adenopathy. Axial contrast-enhanced CT scan demonstrates punctate calcification within low-attenuation ring-enhancing lymph node (arrow), posterolateral to right internal jugular vein. Calcification within right intraparotid adenopathy (long arrow) is visible. Two foci of left-sided skin thickening (arrowheads) adjacent to adenopathy are present.
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FIG 5. Case 11: Nine-month-old girl with left parotid mass and right hemiplegia.
A, Axial contrast-enhanced CT scan shows focal low density (arrow) within left parotid gland with thickening of adjacent subcutaneous fat and skin.
B, Axial T2-weighted (3200/78/1) fast spin-echo MR image demonstrates high signal intensity involving left corpus striatum (arrows).
C, Axial apparent diffusion coefficient map from line-scan diffusion image (1520/62.5/1; b maximum = 750 s/mm2) shows low signal intensity (arrow) indicating decreased diffusion associated with acute or subacute infarction. Although immunocompetent children with NTM adenitis typically lack systemic symptoms, occurrence of cerebral infarction, possibly owing to vasculitis, in this patient suggests that occasionally the disease process may be more generalized.
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