A neck mass in a patient with fever and sore throat

Parapharyngeal space involvement or association of the parapharyngeal-mediastinalpleural spaces or the retropharyngealmediastinal spaces leads to increased mortality.1 Diagnosis During evaluation of a mass in the parapharyngeal space, the most important landmarks to note on imaging are (1) the deep portion of the parotid gland and the stylomandibular tunnel region; (2) the size, shape, and direction of any displacement of the internal carotid artery; (3) the direction of any fat displacement in the prestyloid compartment; and (4) the effect of a mass on the surrounding structures or areas, including the pharynx and the masticator space.2 As is true of abscesses elsewhere in the body, a parapharyngeal abscess is a low-attenuation necrotic, pus-fi lled crater with a thick, irregular, enhancing rim visible on CT. Deep-space infections are often polymicrobial and can involve any of a number of aerobic or anaerobic bacterial organisms, including Staphylococcus aureus, group G streptococci, Streptococcus viridans, Streptococcus pyogenes, Bacteroides species, Pseudomonas aeruginosa, Klebsiella pneumoniae, peptostreptococci, or Prevotella melaninogenica.1 The presence of a beta-lactamaseproducing organism necessitates use of a beta-lactamase-resistant antibiotic.