ESR Essentials: acute infections of the head and neck-practice recommendations by the European Society of Head and Neck Radiology.

Acute head and neck infections are common in the population and can have serious complications. Prompt diagnosis and treatment are necessary to avoid morbidity and mortality. Imaging is not indicated for uncomplicated acute rhinosinusitis, otomastoiditis, or limited face and neck soft tissue infections (such as tonsillar or odontogenic infections). However, the presence of facial swelling, severe pain, neurological symptoms, and eye signs suggests a complicated infection and warrants emergency imaging. Contrast-enhanced computed tomography (CT) is the primary imaging modality due to its wide availability and ability to show edema and drainable abscesses in the soft tissues, as well as bone resorption. Contrast-enhanced magnetic resonance imaging (MRI) benefits from superior soft tissue contrast, so it may be additive for the demonstration of orbital, skull base, and intracranial complications, as well as neck soft tissue involvement. Complications, such as orbital or intracranial extension, vascular thrombosis, and mediastinal involvement, should be noted on imaging. Follow-up imaging may be required based on clinical grounds and should mention residual disease and surgical drains. KEY POINTS: In uncomplicated head and neck infections, emergency imaging is not needed. Contrast-enhanced CT or MRI is indicated in complicated sinus and ear infections. In neck soft tissue infections, contrast-enhanced CT or MRI is indicated.