Deep neck infections with mediastinum abscess and respiratory failure in a pediatric patient

Abstract

Abstract Rationale: Deep neck infections are infections of the potential fascial planes and spaces of the head and neck. They can be life-threatening due to complications of upper airway compression or obstruction, sepsis or septic shock or acute respiratory syndrome. The most common pathogens are Streptococcus viridans and Staphylococcus aureus. Patient concerns: A one-year one-month-old girl was admitted to our pediatric emergency department due to fever, rhinorrhea, and erythematous swelling in the right preauricular area for 3 days. A day later, she had dyspnea, dysphagia, decreased activity, and the swelling extended to the right neck area. Diagnosis: The initial soft neck tissue radiograph showed prevertebral soft tissue thickening, and neck sonography revealed hypoechoic nodes, which were highly suggestive of a deep neck infection. Subsequent computed tomography of the neck and chest showed an abscess of the right deep neck spaces over the parapharyngeal, carotid, parotid, and submandibular areas with intrathoracic extension, as well as an abscess over the anterior mediastinum and bilateral empyema. Interventions: Drainage from deep neck incisions and thoracoscopic decortication of the right-side pleura were performed. Outcomes: After appropriate surgical interventions, critical care with antibiotics and ventilator support, the patient's condition stabilized and was discharged home. Lessons: Complications of deep neck infections are potentially fatal, especially in children. Clinicians should be aware of such infections in children and should not underestimate their potential severity. Children with deep neck infections should be more closely monitored throughout their hospitalization.