title: Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings.
abstract: OBJECTIVE
  Infections caused by nontuberculous mycobacteria (NTM) commonly manifest as cervicofacial adenitis in otherwise healthy children. The aim of this study was to characterize the imaging findings of NTM infection of the head and neck in immunocompetent children.
  
  
  METHODS
  The medical records and imaging examinations (CT in 10, MR in two) were reviewed in 12 immunocompetent children with NTM infection of the head and neck.
  
  
  RESULTS
  The usual presentation (n = 9) was of an enlarging, non-tender mass with violaceous skin discoloration, unresponsive to conventional antibiotics. The duration of symptoms was 6 days to 5 months. Imaging revealed asymmetric adenopathy with contiguous low-density ring-enhancing masses in all patients. There was cutaneous extension in 10 patients. Inflammatory stranding of the subcutaneous fat was minimal (n = 9) or absent (n = 2) in 11 patients. The masses involved the submandibular space (n = 3), the parotid space (n = 2), the cheek (n = 1), the anterior triangle of the neck (n = 2), the submandibular and parotid spaces (n = 2), the parotid space and neck (n = 1), and the neck and retropharyngeal space (n = 1). Surgical management included incision and drainage only (n = 2), incision and drainage with curettage (n = 2), excisional biopsy after incision and drainage (n = 1), excisional biopsy only (n = 5), superficial parotidectomy only (n = 1), and superficial parotidectomy with contralateral excisional biopsy (n = 1). All patients improved in response to surgery and long-term antimycobacterial antibiotics.
  
  
  CONCLUSIONS
  NTM infection of the head and neck has a characteristic clinical presentation and imaging appearance. Recognition of this disease is important; appropriate treatment is excision and, in selected cases, antimycobacterial therapy.
authors.affiliation: Department of Radiology, Children's Hospital and Harvard Medical School, Boston, MA 02115, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Robson
authors.forename: R
authors.initials: R
authors.lastname: Hazra
authors.forename: P D
authors.initials: PD
authors.lastname: Barnes
authors.forename: R L
authors.initials: RL
authors.lastname: Robertson
authors.forename: D
authors.initials: D
authors.lastname: Jones
authors.forename: R N
authors.initials: RN
authors.lastname: Husson
mesh_terms: D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008198:Lymph Nodes / Q000473:pathology; D008199:Lymphadenitis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D009164:Mycobacterium Infections / Q000175:diagnosis*; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis*; D010305:Parotid Diseases / Q000175:diagnosis; D010306:Parotid Gland / Q000473:pathology; D013363:Submandibular Gland / Q000473:pathology; D013364:Submandibular Gland Diseases / Q000175:diagnosis; D014057:Tomography, X-Ray Computed