Spontaneous Retropharyngeal Emphysema in a Paediatric Patient; Radiological Findings

Abstract

Retropharyngeal emphysema is a severe condition which may be life-threatening requiring urgent diagnosis and intervention. This condition may occur with subcutaneous emphysema of the cervical region and may also be complicated by mediastinal emphysema and pneumomediastinum. A 9-year-old Nigerian boy was admitted into the emergency unit of a foremost teaching hospital in South Western Nigeria with a 5-hour history of progressively worsening dyspnoea. There was a history of foreign body ingestion - a round plastic ball bearing. Several attempts to remove the foreign body were made by thrusting the fingers down his throat while holding him in a head down position. Urgent x-rays of the neck and chest were performed. The lateral x-ray of the soft tissue neck revealed widening lucency within the prevertebral soft tissue from the basiocciput, extending below the 7th cervical vertebra; which was indicative of spontaneous retropharyngeal emphysema. Streaks of air were also seen in the subcutaneous tissue of the neck. Retropharyngeal emphysema is seldom thought of by clinicians as a differential in the management of patients presenting with acute upper aerodigestive tract conditions. Health education to increase public awareness of the potential ills of some ‘socio-cultural’ practices is of paramount importance in order to reduce the incidence of this potentially life-threatening condition in pediatrics.