DOI: 10.1148/rg.261055050
Causes of Facial Swelling in Pediatric Patients: Correlation of Clinical and Radiologic Findings1
Geetika Khanna, MD,
Yutaka Sato, MD,
Richard J. H. Smith, MD,
Nancy M. Bauman, MD and
Jeffrey Nerad, MD
1 From the Departments of Radiology (G.K., Y.S.), Otolaryngology (R.J.H.S., N.M.B.), and Ophthalmology (J.N.), University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242. Recipient of a Certificate of Merit award for an education exhibit at the 2003 RSNA Annual Meeting. Received March 15, 2005; revision requested April 4 and received May 25; accepted June 6. All authors have no financial relationships to disclose.
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Figure 1. Differential diagnosis of facial swelling according to the location of the lesion.
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Figure 2a. Cervical bacterial lymphadenitis and abscess in a 1-year-old boy with fever. (a) Photograph shows erythematous swelling of the upper neck, which was tender at palpation. Swelling was refractory to antibiotics. (b) Contrast material–enhanced CT scan shows lymphadenitis of the left-sided level 1 nodes (arrow) and associated necrosis (arrowhead) suggestive of early abscess formation.
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Figure 2b. Cervical bacterial lymphadenitis and abscess in a 1-year-old boy with fever. (a) Photograph shows erythematous swelling of the upper neck, which was tender at palpation. Swelling was refractory to antibiotics. (b) Contrast material–enhanced CT scan shows lymphadenitis of the left-sided level 1 nodes (arrow) and associated necrosis (arrowhead) suggestive of early abscess formation.
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Figure 3a. Orbital cellulitis and subperiosteal abscess in an 11-year-old girl with painful swelling. (a) Photograph shows periorbital swelling, proptosis, and chemosis of the right eye. (b) Contrast-enhanced CT scan shows soft-tissue edema and infiltration of the fat plane in the preseptal (*) and extraconal (arrowhead) spaces, as well as a fluid collection under the periorbita (straight arrow) and associated inflammation of the right ethmoidal sinus (curved arrow). The abscess was surgically drained.
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Figure 3b. Orbital cellulitis and subperiosteal abscess in an 11-year-old girl with painful swelling. (a) Photograph shows periorbital swelling, proptosis, and chemosis of the right eye. (b) Contrast-enhanced CT scan shows soft-tissue edema and infiltration of the fat plane in the preseptal (*) and extraconal (arrowhead) spaces, as well as a fluid collection under the periorbita (straight arrow) and associated inflammation of the right ethmoidal sinus (curved arrow). The abscess was surgically drained.
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Figure 4a. Pott puffy tumor in a 14-year-old boy. (a) Photograph shows bilateral periorbital swelling and, in the brow region, a large swollen bump that had a doughy consistency at palpation. (b, c) Contrast-enhanced CT scans show a subgaleal abscess (arrow in b) and frontal sinusitis (c). (Air in the abscess and the sinus was introduced during diagnostic aspiration.)
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Figure 4b. Pott puffy tumor in a 14-year-old boy. (a) Photograph shows bilateral periorbital swelling and, in the brow region, a large swollen bump that had a doughy consistency at palpation. (b, c) Contrast-enhanced CT scans show a subgaleal abscess (arrow in b) and frontal sinusitis (c). (Air in the abscess and the sinus was introduced during diagnostic aspiration.)
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Figure 4c. Pott puffy tumor in a 14-year-old boy. (a) Photograph shows bilateral periorbital swelling and, in the brow region, a large swollen bump that had a doughy consistency at palpation. (b, c) Contrast-enhanced CT scans show a subgaleal abscess (arrow in b) and frontal sinusitis (c). (Air in the abscess and the sinus was introduced during diagnostic aspiration.)
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Figure 5a. Odontogenic masticator phlegmon and abscess in a 15-year-old girl. (a) Contrast-enhanced CT scan shows a right masticator space phlegmon with swelling of the masseter (curved arrow) and pterygoid muscles (straight arrow), as well as a small abscess (arrowhead). (b) CT scan shows phlegmonous changes that extend along the temporalis muscle and into the suprazygomatic masticator space (arrow).
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Figure 5b. Odontogenic masticator phlegmon and abscess in a 15-year-old girl. (a) Contrast-enhanced CT scan shows a right masticator space phlegmon with swelling of the masseter (curved arrow) and pterygoid muscles (straight arrow), as well as a small abscess (arrowhead). (b) CT scan shows phlegmonous changes that extend along the temporalis muscle and into the suprazygomatic masticator space (arrow).
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Figure 6a. Nasofrontal cephalocele in a 6-month-old girl. (a) Photograph shows a midfacial mass at the glabella, with hypertelorism. At palpation, the mass was soft and compressible. (b, c) Plain radiograph (b) and three-dimensional reformatted CT image (c) of the skull base show a bone defect between the nasal and frontal bones (arrows).
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Figure 6b. Nasofrontal cephalocele in a 6-month-old girl. (a) Photograph shows a midfacial mass at the glabella, with hypertelorism. At palpation, the mass was soft and compressible. (b, c) Plain radiograph (b) and three-dimensional reformatted CT image (c) of the skull base show a bone defect between the nasal and frontal bones (arrows).
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Figure 6c. Nasofrontal cephalocele in a 6-month-old girl. (a) Photograph shows a midfacial mass at the glabella, with hypertelorism. At palpation, the mass was soft and compressible. (b, c) Plain radiograph (b) and three-dimensional reformatted CT image (c) of the skull base show a bone defect between the nasal and frontal bones (arrows).
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Figure 7. Naso-orbital cephalocele in a 2-month-old boy with midfacial and orbital swelling. Axial unenhanced CT scan of the orbits shows bilateral naso-orbital bone defects (arrows) and a cephalocele (*), which protrudes into both orbits.
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Figure 8a. Nasal dermoid cyst in a 1-year-old boy. (a) Photograph shows a midfacial mass at the bridge of the nose. (b, c) Axial contrast-enhanced CT scans show a fatty mass at the nasal bridge (arrowhead in b) and intracranial extension of the mass through a bone defect at the foramen cecum (arrow in c). (d) Photograph shows the resected dermal sinus and dermoid cyst.
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Figure 8b. Nasal dermoid cyst in a 1-year-old boy. (a) Photograph shows a midfacial mass at the bridge of the nose. (b, c) Axial contrast-enhanced CT scans show a fatty mass at the nasal bridge (arrowhead in b) and intracranial extension of the mass through a bone defect at the foramen cecum (arrow in c). (d) Photograph shows the resected dermal sinus and dermoid cyst.
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Figure 8c. Nasal dermoid cyst in a 1-year-old boy. (a) Photograph shows a midfacial mass at the bridge of the nose. (b, c) Axial contrast-enhanced CT scans show a fatty mass at the nasal bridge (arrowhead in b) and intracranial extension of the mass through a bone defect at the foramen cecum (arrow in c). (d) Photograph shows the resected dermal sinus and dermoid cyst.
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Figure 8d. Nasal dermoid cyst in a 1-year-old boy. (a) Photograph shows a midfacial mass at the bridge of the nose. (b, c) Axial contrast-enhanced CT scans show a fatty mass at the nasal bridge (arrowhead in b) and intracranial extension of the mass through a bone defect at the foramen cecum (arrow in c). (d) Photograph shows the resected dermal sinus and dermoid cyst.
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Figure 9a. Dacryocystocele in a 2-month-old girl. (a) Photograph shows a bluish inferomedial canthus mass. (b, c) T2-weighted MR images show a cystic mass that extends from the medial canthus (arrow in b) into the nasal cavity (* in c), along the nasolacrimal duct.
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Figure 9b. Dacryocystocele in a 2-month-old girl. (a) Photograph shows a bluish inferomedial canthus mass. (b, c) T2-weighted MR images show a cystic mass that extends from the medial canthus (arrow in b) into the nasal cavity (* in c), along the nasolacrimal duct.
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Figure 9c. Dacryocystocele in a 2-month-old girl. (a) Photograph shows a bluish inferomedial canthus mass. (b, c) T2-weighted MR images show a cystic mass that extends from the medial canthus (arrow in b) into the nasal cavity (* in c), along the nasolacrimal duct.
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Figure 10a. Orbital dermoid cyst in a 7-year-old boy. (a) Photograph shows a mass in the upper outer orbital quadrant. (b) Contrast-enhanced CT scan shows a fatty mass lesion (*) in the lateral aspect of the right orbit, adjacent to the frontozygomatic suture, with osseous scalloping that produces the appearance of a fossa (arrow). The cyst was surgically removed.
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Figure 10b. Orbital dermoid cyst in a 7-year-old boy. (a) Photograph shows a mass in the upper outer orbital quadrant. (b) Contrast-enhanced CT scan shows a fatty mass lesion (*) in the lateral aspect of the right orbit, adjacent to the frontozygomatic suture, with osseous scalloping that produces the appearance of a fossa (arrow). The cyst was surgically removed.
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Figure 11. First branchial cleft cyst. Coronal CT scan shows a cystic mass in the parotid gland (arrow) that is connected with a smaller cyst in the external auditory canal at the osseocartilaginous junction (arrowhead).
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Figure 12a. Plexiform neurofibroma in a 7-year-old girl with type 1 neurofibromatosis. (a) Photograph shows protrusion of the right side of the face and exophthalmos. Swelling and protrusion were slowly progressive, and the exophthalmos was pulsatile at palpation. (b) Contrast-enhanced T1-weighted fat-saturated axial MR image shows a poorly demarcated enhancing mass lesion that extends from the subcutaneous soft tissue into the orbit (arrow), middle cranial fossa (*), and cavernous sinus (arrowhead). (c) Three-dimensional reformatted CT image shows an enlarged right orbit, with marked widening of the superior orbital fissure (arrow).
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Figure 12b. Plexiform neurofibroma in a 7-year-old girl with type 1 neurofibromatosis. (a) Photograph shows protrusion of the right side of the face and exophthalmos. Swelling and protrusion were slowly progressive, and the exophthalmos was pulsatile at palpation. (b) Contrast-enhanced T1-weighted fat-saturated axial MR image shows a poorly demarcated enhancing mass lesion that extends from the subcutaneous soft tissue into the orbit (arrow), middle cranial fossa (*), and cavernous sinus (arrowhead). (c) Three-dimensional reformatted CT image shows an enlarged right orbit, with marked widening of the superior orbital fissure (arrow).
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Figure 12c. Plexiform neurofibroma in a 7-year-old girl with type 1 neurofibromatosis. (a) Photograph shows protrusion of the right side of the face and exophthalmos. Swelling and protrusion were slowly progressive, and the exophthalmos was pulsatile at palpation. (b) Contrast-enhanced T1-weighted fat-saturated axial MR image shows a poorly demarcated enhancing mass lesion that extends from the subcutaneous soft tissue into the orbit (arrow), middle cranial fossa (*), and cavernous sinus (arrowhead). (c) Three-dimensional reformatted CT image shows an enlarged right orbit, with marked widening of the superior orbital fissure (arrow).
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Figure 13a. Infantile capillary hemangioma in a 1-month-old girl. (a) Photograph shows a strawberry-colored lesion and swelling of the left cheek. (b) T2-weighted MR image shows a hyperintense left parotid mass with multiple flow voids.
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Figure 13b. Infantile capillary hemangioma in a 1-month-old girl. (a) Photograph shows a strawberry-colored lesion and swelling of the left cheek. (b) T2-weighted MR image shows a hyperintense left parotid mass with multiple flow voids.
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Figure 14. Venous malformations. Photograph shows a port-wine stain on the left cheek of a 5-year-old boy.
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Figure 15a. Venous malformations. T1-weighted MR images obtained without (a) and with (b) the use of contrast material and fat saturation in a 4-year-old boy show a T1-hypointense focal mass in the right buccal space (arrow) that appears intensely enhanced in b.
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Figure 15b. Venous malformations. T1-weighted MR images obtained without (a) and with (b) the use of contrast material and fat saturation in a 4-year-old boy show a T1-hypointense focal mass in the right buccal space (arrow) that appears intensely enhanced in b.
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Figure 16a. Leontiasis ossea caused by fibrous dysplasia in a 5-year-old boy. (a) Photograph shows swelling of the right malar region, protrusion of the right cheek, and loss of the nasomaxillary angle, which cause a feline facial appearance. (b) Axial CT scan shows a fibro-osseous lesion that involves the right maxillary bone. (c) Three-dimensional reformatted CT image shows protuberance of the right maxilla and loss of the nasomaxillary angle (arrowhead).
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Figure 16b. Leontiasis ossea caused by fibrous dysplasia in a 5-year-old boy. (a) Photograph shows swelling of the right malar region, protrusion of the right cheek, and loss of the nasomaxillary angle, which cause a feline facial appearance. (b) Axial CT scan shows a fibro-osseous lesion that involves the right maxillary bone. (c) Three-dimensional reformatted CT image shows protuberance of the right maxilla and loss of the nasomaxillary angle (arrowhead).
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Figure 16c. Leontiasis ossea caused by fibrous dysplasia in a 5-year-old boy. (a) Photograph shows swelling of the right malar region, protrusion of the right cheek, and loss of the nasomaxillary angle, which cause a feline facial appearance. (b) Axial CT scan shows a fibro-osseous lesion that involves the right maxillary bone. (c) Three-dimensional reformatted CT image shows protuberance of the right maxilla and loss of the nasomaxillary angle (arrowhead).
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Figure 17a. Plunging ranula in a 16-year-old girl with slowly progressive but painless swelling beneath the chin. (a) Photograph shows swelling of the left submental region. (b, c) T2-weighted MR images show a large submandibular cystic mass (* in b) with a diameter that progressively narrows toward the sublingual space (arrow in c), in a comet-tail configuration.
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Figure 17b. Plunging ranula in a 16-year-old girl with slowly progressive but painless swelling beneath the chin. (a) Photograph shows swelling of the left submental region. (b, c) T2-weighted MR images show a large submandibular cystic mass (* in b) with a diameter that progressively narrows toward the sublingual space (arrow in c), in a comet-tail configuration.
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Figure 17c. Plunging ranula in a 16-year-old girl with slowly progressive but painless swelling beneath the chin. (a) Photograph shows swelling of the left submental region. (b, c) T2-weighted MR images show a large submandibular cystic mass (* in b) with a diameter that progressively narrows toward the sublingual space (arrow in c), in a comet-tail configuration.
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Figure 18a. Orbital rhabdomyosarcoma in a 4-year-old girl with progressive ptosis and decrease in visual acuity. (a) Photograph shows ptosis of the left eye. (b) Contrast-enhanced CT scan shows a homogeneously enhancing orbital mass (*), in the inner superior quadrant, that displaces and deforms the globe.
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Figure 18b. Orbital rhabdomyosarcoma in a 4-year-old girl with progressive ptosis and decrease in visual acuity. (a) Photograph shows ptosis of the left eye. (b) Contrast-enhanced CT scan shows a homogeneously enhancing orbital mass (*), in the inner superior quadrant, that displaces and deforms the globe.
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Figure 19a. Rhabdomyosarcoma in a 7-year-old boy with rapidly progressive swelling of the jaw. (a) Photograph shows swelling of the left side of the jaw. (b) Contrast-enhanced T1-weighted MR image shows a large and enhancing masticator space mass (*) that displaces the parotid gland posterolaterally (black arrow) and the parapharyngeal fat posteromedially (white arrow).
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Figure 19b. Rhabdomyosarcoma in a 7-year-old boy with rapidly progressive swelling of the jaw. (a) Photograph shows swelling of the left side of the jaw. (b) Contrast-enhanced T1-weighted MR image shows a large and enhancing masticator space mass (*) that displaces the parotid gland posterolaterally (black arrow) and the parapharyngeal fat posteromedially (white arrow).
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Figure 20a. Mandibular Ewing sarcoma in an 8-year-old boy with rapidly progressive swelling and paresthesias of the right cheek. (a) Photograph shows severe swelling of the right side of the face. At palpation, a solid nonmobile mass was found. (b) CT scan shows a mass in the masticator space (arrows), with associated destruction of the mandibular bone and with a sunburst-shaped periosteal reaction (arrowhead).
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Figure 20b. Mandibular Ewing sarcoma in an 8-year-old boy with rapidly progressive swelling and paresthesias of the right cheek. (a) Photograph shows severe swelling of the right side of the face. At palpation, a solid nonmobile mass was found. (b) CT scan shows a mass in the masticator space (arrows), with associated destruction of the mandibular bone and with a sunburst-shaped periosteal reaction (arrowhead).
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Figure 21a. Langerhans cell histiocytosis in a 1-year-old girl with left-sided proptosis. (a) CT scan shows a lytic lesion of the frontal and sphenoid bones (arrows) and an associated soft-tissue mass that extends into the orbit. (b) CT scan shows destruction of the temporal bone (arrowhead).
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Figure 21b. Langerhans cell histiocytosis in a 1-year-old girl with left-sided proptosis. (a) CT scan shows a lytic lesion of the frontal and sphenoid bones (arrows) and an associated soft-tissue mass that extends into the orbit. (b) CT scan shows destruction of the temporal bone (arrowhead).
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Figure 22a. Metastatic neuroblastoma in a 1-year-old boy. (a) Photograph shows periorbital ecchymosis and swelling suggestive of traumatic head injury. (b, c) Coronal MR images obtained before (b) and after (c) the administration of a gadolinium-based contrast agent demonstrate bilateral soft-tissue masses with extensive skull-base infiltration (arrows in b) and orbital encroachment. (d) Contrast-enhanced CT scan of the abdomen demonstrates a left adrenal mass (arrow), which was subsequently proved to be a neuroblastoma.
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Figure 22b. Metastatic neuroblastoma in a 1-year-old boy. (a) Photograph shows periorbital ecchymosis and swelling suggestive of traumatic head injury. (b, c) Coronal MR images obtained before (b) and after (c) the administration of a gadolinium-based contrast agent demonstrate bilateral soft-tissue masses with extensive skull-base infiltration (arrows in b) and orbital encroachment. (d) Contrast-enhanced CT scan of the abdomen demonstrates a left adrenal mass (arrow), which was subsequently proved to be a neuroblastoma.
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Figure 22c. Metastatic neuroblastoma in a 1-year-old boy. (a) Photograph shows periorbital ecchymosis and swelling suggestive of traumatic head injury. (b, c) Coronal MR images obtained before (b) and after (c) the administration of a gadolinium-based contrast agent demonstrate bilateral soft-tissue masses with extensive skull-base infiltration (arrows in b) and orbital encroachment. (d) Contrast-enhanced CT scan of the abdomen demonstrates a left adrenal mass (arrow), which was subsequently proved to be a neuroblastoma.
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Figure 22d. Metastatic neuroblastoma in a 1-year-old boy. (a) Photograph shows periorbital ecchymosis and swelling suggestive of traumatic head injury. (b, c) Coronal MR images obtained before (b) and after (c) the administration of a gadolinium-based contrast agent demonstrate bilateral soft-tissue masses with extensive skull-base infiltration (arrows in b) and orbital encroachment. (d) Contrast-enhanced CT scan of the abdomen demonstrates a left adrenal mass (arrow), which was subsequently proved to be a neuroblastoma.
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Copyright © 2006 by the Radiological Society of North America.
