UMEM Educational Pearls

Title: What's the diagnosis? Written by Danya Khoujah, MD

Posted: 7/8/2012 by Haney Mallemat, MD (Updated: 7/9/2012)
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Question

A previously healthy 3 year-old male presents with a one-day history of fever, drooling, and refusal to move his neck. The lateral neck x-ray is shown. What's the diagnosis?

Answer

Answer: Retropharyngeal abscess

Retropharyngeal Abscess (RPA)

Commonly diagnosed in young children because the retropharyngeal space contains lymph nodes that atrophy before puberty; there is an increasing incidence in adults
Etiologic bacteria: Aerobic (e.g., Beta-hemolytic Strep and Staph), anaerobic (e.g., Bacteroides), or gram-negative species (e.g., Haemophillus); 50% of cases preceded by a URI
Signs / Symptoms: fever, drooling, sore throat, dysphagia, stiff neck, vocal changes (e.g., "hot-potato" voice), stridor, or respiratory distress.
Radiologic studies
- Lateral X-ray with soft tissue swelling, gas, or air-fluid levels.
- Neck CT w/ IV contrast (definitive) defines the presence of an abscess, extent of disease, and presence of cellulitis.
Treatment: Antibiotics with or without surgical drainage
Complications: mediastinitis, epidural abscess, sepsis, airway obstruction, and jugular venous thrombosis.

References

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