Pre-Sternal Abscess associated with Deep Neck Infection.

Abstract

Deep neck space infections (DNSI) involve deep fascial space in the head and neck area and is a challenging problem because of variable clinical manifestations.[1] Accurate diagnosis and effective treatment of DNSIs is critical for successful man-agement because of their rapidly progressive nature in children. Figure 1: Deep neck infection was located mainly in the right ceA previously healthy 2-year-old girl presented with a 2-day history of fever and right cervical lymphadeni-tis. History revealed acute otitis media two weeks ago. Physical examination of the head, neck, and oropharynx revealed hyperemic oropharynx. Her white blood cell count (WBC) and C-reactive protein (CRP) were 15400 109/L and 8.7 mg/L, respectively. The patient was hospitalized with a diagnosis of deep neck infection and empiric antibiotic treatment with sulbactam-ampicillin was started. The blood culture was negative. A pre-sternal mass of 10 cm in diameter was noticed on fifth day of hospitalization [Fig. 1]. The posteroanterior chest radiograph showed air in the soft tissue at the level of right cer-vical and interclavicular region [Fig. 2 (a), (b)]. Fur-ther imaging with contrast-enhanced computerized tomography (CT) of the neck and thorax demon-strated subcutaneous edema and soft tissue swelling with large abnormal air collections suggesting ab-scess formation from the right cervical region to the anterior chest wall [Fig. 2 (c), (d)]. Due to rapid pro-gression even under antimicrobial treatment, antibi-otic therapy was changed to meropenem, clindamy-cin, and vancomycin in addition to surgical incision and drainage. Twenty milliliter of pus was drained and the culture of the exudate grew Streptococcus anginosus sensitive to vancomycin. Primary immu-nologic work-up was found to be normal. Patient was discharged home after 15 days of hospitalization.