Baylor University Medical Center Proceedings October 2017 - 462

Figure. (a) Axial, (b) sagittal, and (c) coronal postcontrast spiral computed tomography of the neck and submandibular area demonstrating a 1.3 × 1.3 × 1.8 cm
multiloculated rim-enhancing fluid collection inferior to the angle of the left mandible.

the tonsils and pharynx; bilateral disease is usually related to
viral infections (6).
The preferred initial imaging is ultrasound due to cost,
feasibility, and lack of radiation. This can deﬁne the mass in
size, vascularity, location, shape, and consistency of mass (7).
Computed tomography scan with contrast is useful for exact
location of the abscess for surgical planning in patients refractory to medical management (8). Clinical and radiographic
evidence alone is usually suﬃcient to diagnose a pediatric neck
mass. In our case, drainage and intravenous antibiotics were
used concurrently for management to reduce the progression
to life-threatening complications.
This case was unique not only in the undetermined cause
of the neck abscess, but the fact that it presented in an 8-dayold infant with no indication of abnormal anatomy or immunodeﬁciency. In addition, the patient did not have any of
the typical symptoms of a deep neck abscess including fever,
irritability, stridor, poor feeding, dysphagia, drooling, or respiratory distress.
The main cause of abscess in the neonatal period is trauma
or acute contiguous infection (1). With our patient's history of
being in the nursery for 6 days after birth, spending 1 day at
home before presentation, and having an abscess that produced
MRSA, it is conceivable that he received this infection while
in the hospital. The prevalence of MRSA-positive nasal carriers
of admitted patients at Baylor Scott and White in 2008 was
10.8%, of whom 85.3% were asymptomatic (9). Of neonatal
MRSA infections, abscess/cellulitis has been shown to be the
most common presentation (10). Fortunov et al concluded that

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male infants at 7 to 12 days of age are most at risk for neonatal MRSA infections (10). This infection could have been
introduced from the mother handling the patient, which could
produce subclinical breaks in the patient's skin, allowing bacteria
to colonize the wound.
1.

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6. Park YW. Evaluation of neck masses in children. Am Fam Physician
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7. Meier JD, Grimmer JF. Evaluation and management of neck masses in
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8. Staﬀel G. Pediatric otolaryngology. In Wax M, ed. Primary Care Otolaryngology, 3rd ed. Alexandria, VA: American Academy of OtolaryngologyHead and Neck Surgery, 2011:129-130.
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Baylor University Medical Center Proceedings

Volume 30, Number 4

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017