Retropharyngeal Abscess complicated by mediastinitis in infants.

Abstract

Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy. We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period. All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks - 11 months and all tested negative for Human Immunodeficiency Virus (HIV). The diagnosis and complication were confirmed on Computerised Tomography (CT) scan. The CT scans consistently revealed retropharyngeal abscesses with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery and the other 4 were extubated in the PICU, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases. Management of these cases may be challenging and young children with RPA require close care and airway monitoring. CT or Magnetic Resonance Imaging (MRI) is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24-48 hours to medical management.