Diagnosis Of Retropharyngeal Abscess Research Articles

Retropharyngeal Abscess as an Uncommon Cause of Torticollis in a Child

Torticollis is a clinical manifestation of musculoskeletal pathologies and it is often underestimated as the first symptom of an infection of the retropharyngeal space. It accounts for about one-fourth of retropharyngeal abscess (RPA) presentations in children. Early imaging studies may help to get the diagnosis of RPA and to offer prompt surgical intervention to avoid complications such as upper airway obstruction. Thus, torticollis should not be only treated symptomatically without the exclusion of serious retropharyngeal abscess because a delay in the definitive diagnosis and implementation of adequate therapy may be fatal.

Retropharyngeal Abscess with Clival Osteomyelitis Caused by Staphylococcus intermedius and Staphylococcus aureus in a 6-Year-old Boy.

To the Editors: In the March 2023 issue of PIDJ, we read a case report of septic arthritis of the atlanto-occipital joint caused by Staphylococcus intermedius, Di Siena, and coworkers. In our hospital, we treated a similar case of a 6-year-old boy with a retropharyngeal abscess and clival osteomyelitis caused by S. intermedius and S. aureus. Our patient was a 6-year-old previously healthy boy. He presented with a low-grade fever (38.3 max.), headaches and torticollis. At a local hospital, computed tomography of the head and neck was performed, and a diagnosis of retropharyngeal abscess was established. The patient was sent to our clinic for additional workup and therapy. His blood count was 8600 L/cmm with a neutrophil predominance of 76%. C-reactive protein was 81.7 mg/L. The rest of the routine biochemical tests were unremarkable. The throat swab test results were negative. Two sets of blood cultures taken before antimicrobial therapy were sterile. We consulted an otolaryngology specialist who performed an adenoidectomy with incision and drainage of the retropharyngeal abscess on the third day of hospitalization. A sample of pus sent for culture showed growth of S. intermedius sensitive to penicillin, ampicillin, ceftriaxone and vancomycin. A wound swab taken during the operation showed the growth of S. intermedius (same sensitivity) and S. aureus, sensitive to penicillin and flucloxacillin but resistant to clindamycin. The patient gradually defervesced in 3 days and was continuously afebrile until discharge. First few days, he had mild dysphagia with apparent torticollis, and his head was slightly inclined to the left. After the operation, his neck movements gradually increased, and his headache and dysphagia ceased. We started treatment with cefazoline and clindamycin for the first 2 days and then with vancomycin and meropenem for 7 days, pending microbiological results. After gaining insight into the microbiology results, we changed the therapy to penicillin G. Total intravenous therapy was 21 days. After discharge from the hospital, treatment with amoxicillin was continued for the next 3 weeks. On the 10th day of hospitalization, we performed magnetic resonance (MR) of the head and neck, which showed liquid collection (18 × 5 mm, laterolateral and anterioposterior, respectively) at the site of the retropharyngeal abscess incision downwards to C3. It also showed destruction of the clivus 11 × 8 × 10 mm (craniocaudal, anterioposterior and laterolateral, respectively), reaching the periosteum and dura mater but without forming an epidural liquid collection. The remaining MR images were unremarkable (Fig. 1A and C).FIGURE 1.: A: Sagittal short tau inversion recovery image: hyperintense signal in clivus indicates bone edema (thick arrow); hyperintense signal in epipharynx indicates edema and fluid collection (thin arrow). B: Sagittal short tau inversion recovery image: minimal residual hyperintense signal in the clivus—almost complete regression (thick arrow); normal finding in the epipharynx (thin arrow). C: Axial T2 image: hyperintense signal in the epipharynx indicates edema and fluid collection (white arrow). D: Axial T2 image: normal finding of epipharynx (white arrow).On the control visit, the patient was completely well and had free neck movement, with no fever or pain. His inflammatory markers (erythrocyte sedimentation rate and C-reactive protein) and blood count were normal. Control MR of the head and neck showed minimal residual changes (Fig. 1B and D). In conclusion, we treated a 6-year-old, previously healthy boy with a retropharyngeal abscess and clival osteomyelitis caused by S. intermedius and penicillin-sensitive S. aureus. Treatment consisted of incision and drainage of the retropharyngeal abscess and antimicrobial treatment for 6 weeks, including 3 weeks of intravenous and 3 weeks of oral therapy. The patient did well, and the treatment ended with the complete resolution of the inflammatory changes. We think that it is important to bear in mind that children with pyogenic processes of the head and neck, such as retro/parapharyngeal or peritonsillar abscess, paranasal sinusitis and otitis/mastoiditis, could also have osteomyelitis of the base of the skull because it requires prolonged antimicrobial therapy.1–4

Disparate Presentations of Retropharyngeal Abscess: An Experience From a Tertiary Care Centre.

To discuss the varied presentations, diagnosis, and prompt management of retropharyngeal abscess for academic importance. A retrospective study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery in Belagavi district of Karnataka. Six cases of varied age group with diagnosis of retropharyngeal abscess were studied during two-year period from January 2019 to January 2021. Thorough assessment of all cases was done which included symptoms at the time of presentation, clinical examination findings, imaging studies and laboratory results, medical and surgical interventions. Six patients (4 males, 2 females) were diagnosed as having Retropharyngeal abscess. Youngest age of presentation was 2 month infant. The most common symptoms at presentation included fever and odynophagia seen in all six patients. The clinical examination revealed bulge in posterior pharyngeal wall in all cases, cervical lymphadenopathy in one case, drooling of saliva in three and stridor in one patient, diffuse neck swelling in two ptatients, and trismus in two patients. Contrast Enhanced Computerized Tomographic (CECT) scanning was performed in five patients and one patient underwent Magnetic Resonance Imaging (MRI). The abscess was surgically drained in all patients and received intravenous antibiotics after which there was significant improvement. Retropharyngeal space infection if left untreated, they carry the potential to cause life-threatening complications and death. Although with availability of broad-spectrum antibiotics, the mortality rate is low, appropriate and successful management requires a thorough understanding of the anatomy of the neck, knowledge of usual causative organisms and appropriate medical and surgical management.

Pediatric Upper Airway Obstruction

Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses. This review contains 5 figures, 10 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor

Pediatric Upper Airway Obstruction

Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses. This review contains 5 figures, 13 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor

Pediatric Upper Airway Obstruction

Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses. This review contains 5 figures, 13 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor

Pediatric Upper Airway Obstruction

Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses. This review contains 5 figures, 13 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor

Pediatric Upper Airway Obstruction

Upper airway obstruction is a common reason that children present for emergency care, and causes range from simple and benign etiologies to life-threatening conditions requiring emergent intervention. Both congenital and acquired conditions can result in airway obstruction at various levels, and due to the high risk of acute decompensation associated with some of these conditions, rapid diagnosis and treatment are essential. This review covers assessment and stabilization, diagnosis, and treatment of foreign-body aspiration, croup, bacterial tracheitis, epiglottitis, peritonsillar abscess, and retropharyngeal abscess. Figures show a diagram of the pediatric airway, an anteroposterior radiograph of the neck demonstrating the characteristic “steeple sign” in croup, an algorithm for the treatment of croup, lateral radiographs demonstrating a thickened epiglottis, consistent with a diagnosis of epiglottitis, and a widening of the prevertebral soft tissues of the neck, consistent with a diagnosis of retropharyngeal abscess. Tables list causes of upper airway obstruction by anatomic location, symptoms of upper airway obstruction by anatomic location, severity of croup, and microbiology of deep neck abscesses. This review contains 5 figures, 13 tables, and 32 references Key words: Upper airway obstruction; Pediatric upper airway obstruction, Foreign-body aspiration, Croup, Bacterial tracheitis, Epiglottitis, Peritonsillar abscess, Retropharyngeal abscess, Stridor

Retropharyngeal Abscess in a Four Month Old Female Infant-Case Report

Retropharyngeal abscess is acute suppurative infection of the retropharyngeal space. Most commonly it occurs in children younger than four years of age having history of streptoccocal pharyngitis. Clinical presentation similar to epiglottitis or foreign body aspiration makes distinguishing issues so the diagnosis of retropharyngeal abscess can initially be missled. Here we are illustrating four month old female infant with incipient presentation that clinically resembles epiglottitis. After the initial management in the intensive care unit clinical work-up was continued with multidysciplinary collaboration and the diagnosis of retropharyngeal abscess was given, treated both surgically and conservatively. Postoperative intensive care was then continued with subsequent clinical and biochemical improvement. This case demonstrates the need for broad thinking when dealing with affebrile child being respiratory distressed and during diagnostic work-up of a patient having fever of unknown origin.

Retropharyngeal Abscess in Adults: Five Case Reports and Review of the Literature

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

Index of Suspicion * Case 1: Fever, Barking Cough, Stridor, and Rash in an Infant * Case 2: Erythematous Papulovesicular Rash in a 3-month-old Girl * Case 3: Vomiting and Unrelenting Headaches in a 5-year-old Girl

A 6-month-old boy presents with a temperature of 38.9°C and barking cough of 3 days’ duration as well as a rash over his body for 1 day. On physical examination, his temperature is 37.5°C, respiratory rate is 28 breaths/min, and blood pressure is 87/52 mm Hg. He appears nontoxic and has a barking cough, injected conjunctiva with whitish discharge, dry lips, mild inspiratory stridor, a blanching erythematous maculopapular rash on his trunk and extremities, and small cervical lymph nodes. The rest of his physical findings are normal. His Hgb is 12.8 g/dL (128 g/L), WBC count is 11.7×103/mcL (11.7×109/L) with 75% neutrophils and 23% lymphocytes, and platelet count is 515×103/mcL (515×109/L). His stridor is considered to be due to viral croup, and he is treated with intramuscular (IM) dexamethasone and nebulized racemic epinephrine. A lateral neck radiograph reveals widening of the retropharyngeal space (Fig. 1), and he is started on clindamycin. CT scan of the neck reveals a right retropharyngeal abscess (Fig. 2). He continues to have high spiking fevers and experiences stridor at rest. He is started on IM dexamethasone every 6 hours, and his fever subsides the following day. Figure 1. Lateral neck radiograph showing widening of the retropharyngeal space. Figure 2. CT scan of the neck showing a right retropharyngeal abscess (arrow). On hospital day 6, the corticosteroids are stopped, but the fever returns the following day. Two days later, an erythematous maculopapular rash reappears, and the child’s lips are dry and cracked. On day 10, repeat CT scan shows that the retropharyngeal abscess has resolved. An additional imaging study reveals the cause of his symptoms. A 3-month-old previously healthy girl presents to the ED with a 1-day history of a blistering rash. Her parents noted an erythematous area on her occiput after …

Surgical management of retropharyngeal abscesses

Conclusion: Retropharyngeal abscess (RPA) is a rare, potentially life-threatening disease, requiring appropriate otorhinolaryngologic as well as radiologic diagnostics, and medical and surgical intervention by a transoral, transcervical or transnasal approach in a multidisciplinary setting. Objectives: The risks and benefits of surgical intervention in patients with RPA were assessed. The main outcome measure was the clinical resolution of the abscess. Patients and methods: A retrospective chart review was performed at a tertiary care university hospital over a period of 28 months. Eleven patients aged 1 to 68 years with the diagnosis of RPA were included. Results: All patients presented with restricted cervical mobility and all patients had CT and/or MRI scan on admission. The mean abscess volume was 9.4 cm3. Surgical intervention was performed in all cases, including transoral (n=5), transcervical (n=3) or combined transoral and transcervical (n=2) drainage. In one patient RPA close to the skull base was drained by an MRI-guided transnasal approach. All patients recovered; however, there was one recurrence and in one case surgical tracheotomy was unavoidable during the course of disease. Growth of streptococcal species was verified in six of the examined abscesses. Abscessing lymphadenitis, infection of a cervical cyst, and previous ganglionar local opioid analgesia treatment were identified as causative factors.

In Brief: Retropharyngeal Abscess

Head and Neck Space Infections in Infants and Children. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez-Valdepena H, Bluestone CD. Otolaryngol Head Neck Surg. 1995;112:375–382Retropharyngeal Abscess in Children: A 10-year Study. Al-Sabah B, Bin Salleen H, Hagr A, Choi-Rosen J, Manoukian JJ, Tewfik TL. J Otolaryngol. 2004;33:352–355Retropharyngeal Abscess in Children: Clinical Presentation, Utility of Imaging and Current Management. Craig FW, Schunk JE. Pediatrics. 2003;111:1394–1398Retropharyngeal and Parapharyngeal Infections in Children: The Toronto Experience. Daya H, Lo S, Papsin BC, et al. Int J Pediatr Otorhinolaryngol. 2005;69:81–86Retropharyngeal abscess is an infrequent but serious condition. Early diagnosis can help prevent the potential consequences of airway compromise, sepsis, and extension to contiguous structures. The peak incidence occurs in 3- to 5-year-olds, likely due to the increased number of lymph nodes in the retropharyngeal space and the likelihood of atrophy of lymph nodes in this anatomic space as the child ages.The retropharyngeal space is a potential space anterior to the prevertebral fascia that extends from the skull base to the bifurcation of the trachea in the mediastinum, serving as a potential pathway to the chest. Most cases of retropharyngeal abscess occur in children following an upper respiratory tract infection such as tonsillitis, pharyngitis, and lymphadenitis and probably represent spread of infection from contiguous areas. Some cases are idiopathic; the remainder (more common in older age groups) are due to trauma, foreign body ingestion, or immunocompromised state.Infection nearly always is polymicrobial and commonly includes aerobes (Streptococcus viridans, group A Streptococcus, Staphylococcus aureus, S epidermidis) as well as anaerobes (Bacteroides, Fusobacterium, Peptostreptococcus sp). Throat swabs may not be useful and are likely to represent oropharyngeal flora. Additionally, many patients already may be receiving antibiotics at the time of diagnosis.The clinical presentation of retropharyngeal abscess appears to be highly inconsistent; symptoms may include neck pain, neck swelling, fever, sore throat, and food refusal by younger patients. Limitation of neck movement (particularly with hyperextension) or torticollis seems to be an especially important clue. Respiratory distress or stridor occurs less frequently than commonly believed, and most patients do not appear “toxic.” Often, the differential diagnosis includes pharyngitis, cervical adenitis, meningitis, epiglottitis, and cellulitis.Soft-tissue films of the neck may reveal prevertebral swelling, which can be determined quickly by comparing the width of the prevertebral soft-tissue plane to the corresponding vertebral body. This width should be less than one half the width of the corresponding vertebral body. More precise measurements are usually obtained at C2, where the soft-tissue space can be up to 7 mm in width, and at C6, where it can be up to 14 mm (22 mm in adults). However, the prevertebral space may appear falsely enlarged during neck flexion or crying. Computed tomography (CT) remains the best imaging method to confirm the diagnosis, although it has been demonstrated to have a low sensitivity (43%) and specificity (63%) in distinguishing between retropharyngeal abscess and cellulitis. CT scan is helpful to assess the extent of the infection and determine if it has spread to contiguous structures. However, such scans introduce issues of sedation (particularly problematic if there are airway issues) and additional radiation. Ultrasonography of the affected region is technically difficult.Traditional management of a retropharyngeal abscess has involved transoral surgical drainage. However, recent published pediatric reviews suggest that only 25% to 50% of patients require surgery; most pediatric patients can be treated successfully with medical therapy alone as long as there is no airway compromise. Thus, it may be appropriate to wait 24 to 48 hours while the patient is receiving broad-spectrum antibiotics before considering surgical intervention. Clindamycin remains the first-line antibiotic choice. Given the polymicrobial nature of this disease and the increasing frequency of resistance to clindamycin, it may be useful to expand antibiotic coverage to include either a third-generation cephalosporin or a beta-lactamase-resistant penicillin in geographic areas where clindamycin resistance is present.Comment: The diagnosis of retropharyngeal abscess can be challenging, and clinicians must keep it in their differential diagnosis. Although CT of the neck has become the gold standard in diagnosis, a lateral neck radiograph remains helpful for clinical sites where access to CT may be difficult or to help rule in the diagnosis when nonspecific signs or symptoms exist. Research studies have demonstrated the effectiveness and safety of initial treatment of children who have no airway compromise with antibiotics for 48 hours rather than immediate surgical drainage. These findings have advanced the treatment of retropharyngeal abscess and prevented many children unnecessary morbidity from exposure to anesthesia and surgical intervention.

Absceso epidural cervical como causa de tetraparesia

An epidural spinal abscess is a rare clinical condition which may cause rapid, irreversible neurological deterioration. Usually, the patient presents with back pain in the affected spinal segment, but the condition is rarely considered in the differential diagnosis. A 57 year old man with no significant clinical history initially consulted complaining of cervicalgia. Some days later, this had worsened and he also had odinophagia, fever and general malaise. A diagnosis of retropharyngeal abscess was made. He was admitted to the Ear, Nose and Throat Department (ENT) and antibiotic treatment started with ceftazidime, vancomycin and clindamycin. Eight hours after admission he complained of paresthesia and subsequently of flaccid tetraparesia. CT and MR showed the presence of a paravertebral mass which extended to the epidural space between the fourth and seventh cervical vertebrae. On suspicion of a retropharyngeal abscess complicated by an epidural spinal abscess we proceeded to emergency operation and drained the prevertebral and epidural pus. On microbiological culture St. aureus was grown. The patient regained the mobility of his limbs. On discharge from hospital he still had paresia of the right leg, although this did not impede walking. It should not be forgotten that, although rare, one of the causes of spinal compression and neurological deterioration (particularly in a febrile patient) is an epidural spinal abscess. Prompt diagnosis and satisfactory surgical decompression are essential to avoid irreversible neurological sequelae.

Retropharyngeal abscess and Epstein-Barr virus infection in children.

A 6-year retrospective chart review was conducted of all pediatric patients with the diagnosis of retropharyngeal abscess (RPA) at the Columbia-Presbyterian Medical Center. The charts were examined for signs, symptoms, and serologic findings consistent with recent acute Epstein-Barr virus (EBV) infection. Of the 7 patients we studied, 4 had elevated immunoglobulin G antibodies that were consistent with recent acute EBV infection, and 3 patients were not tested. The 4 patients with positive titers also presented with signs typical for acute EBV infection, including fever (3/4), lymphadenopathy (4/4), and pharyngitis (4/4). Of note, the 2 patients who were older than expected for RPA (ages 18 and 11) had the most severe infections. We submit that there may be a role for EBV infection in the pathogenesis of RPA formation in children. Increasing age may correlate with a more severe infection in this setting.

Clinical indicators of childhood retropharyngeal abscess

Retropharyngeal abscess is a rare but distinctive cause of airway obstruction in childhood. Early recognition permits emergent airway management and surgical drainage. Even when the presentation is insidious and does not include respiratory compromise, early clinical diagnosis of retropharyngeal cellulitis and appropriate medical treatment may halt progression to an abscess. Delay in the diagnosis and management of a retropharyngeal abscess may lead to potentially lethal complications involving vital structures. A case of an infant whose diagnosis of retropharyngeal abscess was delayed because of absence of respiratory compromise is reported. Relapse of retropharyngeal abscess despite surgical drainage and appropriate antibiotic treatment was a complication of infection in this patient. Clinical indicators providing an early diagnosis of retropharyngeal infection, and aspects of evaluation, management, and outcome, are discussed.

化膿性頸椎炎に続発した咽後膿瘍の一例

We recently experienced a case of retropharyngeal abscess caused by pyogenic spondylitis. The patient was a 63-year-old male who visited our department complaining of dysphagia. Diagnosis of retropharyngeal abscess was readily made from the local findings. After discission on the posterior wall of the pharynx profuse drainage of purulent discharge was observed. The inflammation seemed to subside gradually, but the tetraparesis was exacerbating. Pyogenic spondylitis was diagnosed through radiological studies. After this diagnosis was made, orthopedical surgery was performed and the prognosis of this patient seemed to be good.

Retropharyngeal abscess in children: a retrospective and historical analysis.

The charts of 65 pediatric patients with the diagnosis of retropharyngeal abscess were reviewed. These represented a 36-year experience with the disease. The findings were compared with those documented at the turn of the century and were also compared with findings over the last four decades. The data suggests that retropharyngeal abscess may be occurring later in childhood and may not always be preceded by a major detectable infection. Classic diagnostic findings of retropharyngeal bulge and neck stiffness were present in less than half of the patients. Gram-negative and anaerobic organisms are being documented on culture more frequently than in the past. We theorize that liberal use of oral antibiotics prior to admission may have brought about these changes.

Mediastinal Abscess Complicating a Retropharyngeal Abscess

Retropharyngeal abscess is not a rare disease, but its mediastinal complication is only infrequently observed. Hence the reason for this case report. A diagnosis of retropharyngeal abscess is, as a rule, not difficult. The clinical manifestations and the physical fndings are of such a nature that they make the recognition of the disease relatively easy, but with mediastinal abscess, the findings are somewhat obscure. Since the introduction of the x-ray in the study of the soft structures of the neck and chest, the diagnosis of retropharyngeal and mediastinal abscess has been within the reach of everyone who makes use of it. In spite of the above fact, it is indeed surprising to find that the diagnosis is often missed. Greenwald and Messeloff (1), in a review of 55 cases, point out that the diagnosis was not made in many of the cases for as long as three weeks. Neither do they mention the use of x-ray, although this method of examination has been used with great success for a number of years by radiologists. Normal and Morbid Anatomy (Clinical and Physical Findings) The retropharyngeal space is only a potential one located between the posterior pharyngeal wall and the prevertebral layer of the cervical fascia. Above, it is limited by the base of the skull, and below it is continuous with the posterior mediastinal space by the prolongation of the deep layer of the cervical fascia. Its contents consist of lax areolar tissue in which are embedded eight to ten lymph nodes, which tend to retrogress after the age of three, so that in adults there may be only one or two nodes remaining. These glands receive afferent lymphatic vessels from the mucous membrane of the sinuses, Eustachian tubes, and nasopharyngeal region and are very frequently involved in upper respiratory infections. As a rule, they undergo resolution without breaking down, but every now and then suppuration may take place, producing an abscess in the retropharyngeal space which may extend downward behind the larynx and trachea into the posterior space. Caries of the cervical vertebrae, and injury and perforation of the pharynx by foreign bodies are other causes of abscess formation. The accumulation of pus in the retropharyngeal space produces a bulging forward of the posterior wall of the pharynx which encroaches upon the lumen of the pharynx, larynx, and trachea, giving rise to symptoms of obstruction to breathing and swallowing. This mechanical interference is also accompanied by a rise of temperature and other manifestations of an acute pyogenic infection. The abscess may point anywhere in the neck and occasionally may rupture spontaneously. Roentgenologically, the condition can be diagnosed before pronounced physical signs are present. In the case of the neck a lateral view is essential, the anteroposterior view not being of great help in the study of the soft structures.