Retropharyngeal Abscess Research Articles

The COVID-19 period influence on pediatric deep neck abscess: Occurrences and clinical presentation

ObjectiveThe purpose of the study was to investigate the influence of the COVID-19 pandemic on the incidence of deep neck infections (DNIs) in pediatric patients. In addition, it describes the clinical, laboratory, and microbiology presentation as well as the clinical outcomes. Study designRetrospective cohort study. SettingsA single tertiary medical center. MethodsAll patients ≤18 years with a diagnosis of DNI, between the years 2010–2022, were included in the study and the yearly incidence of DNI was calculated. Patients were divided according to their diagnosis of retropharyngeal abscesses (RPAs) and parapharyngeal abscesses (PPAs), and according to age; Group 1 (aged 0 to ≤4 years) and Group 2 (aged>4 to ≤18 years). ResultsA total of 46 cases of DNIs; 24 were RPAs and 22 were PPAs, age group 1 had 20 patients, and age group 2 had 26 patients. The overall DNI incidence during 2010 was 0.81 and declined in 2020 (COVID-19 pandemic period) to 0.33, followed by a surge in the incidence of 4.85 in 2022 (post-COVID-19 period).In age group 1 RPAs were more dominant (70 %) while PPAs were dominant (61.5 %) in group 2. (p = 0.034). A higher prevalence of positive cultures was seen in the RPA group compared to the PPA group (75 % vs 33 %, p = 0.025, respectively), and in age group 1 compared to age group 2 (77 % vs 30 %, p = 0.001, respectively). ConclusionIn conclusion, our study provides valuable insights about the disease and vulnerable communities. In addition, we showed a decrease during the COVID-19 pandemic followed by an increase in DNI incidence post-COVID-19 pandemic era. A larger comprehensive prospective study is warranted to gain a deeper understanding of these trends and their underlying causes.

POCUS Diagnosis of Deep Neck Space Abscess: A Case Series

BackgroundPara and Retropharyngeal abscesses are deep neck infections of early childhood that can be complicated by serious sequelae such as airway obstruction, cervical necrotizing fasciitis, mediastinitis, aspiration pneumonia, jugular thrombosis or aneurysm of the carotid artery. Traditionally, these infections were diagnosed with CT of the neck, which exposes sensitive structures to radiation and may require sedation. Case ReportWe present a case series of four children diagnosed on POCUS with para and/or retropharyngeal abscess later confirmed on CT. All four had alternative working diagnoses on pediatric emergency physician and/or otolaryngology physical examination prior to investigation with POCUS. We also describe a novel imaging approach that allows for easier identification of deep neck anatomic landmarks."Why should an emergency physician be aware of this?"Pediatric emergency physicians should be skilled in imaging the deep neck spaces in order to avoid delayed diagnosis of deep neck space abscess and its potentially catastrophic sequelae.

Posterior Release, Reduction, and Intra-Articular Fusion for Irreducible Type III Atlantoaxial Rotary Fixation.

For irreducible atlantoaxial rotary fixation (AARF), anterior or posterior release was often needed before posterior reduction and fusion. Anterior atlantoaxial joint release has potential complications such as retropharyngeal abscess, persistent hoarseness, and infection. This study aims to assess the efficacy of posterior release, reduction, and intra-articular fusion without resecting the C2 nerve root on irreducible type III AARF. The data of 9 pediatric patients diagnosed with AARF who underwent posterior atlantoaxial release, reduction, and intra-articular fusion without resecting the C2 nerve root were retrospectively reviewed. Japanese Orthopaedic Association scores and Visual Analog Scale for Neck Pain were used to assess outcomes. The preoperative and follow-up assessments of atlantodens interval (ADI) were documented to evaluate the reduction of atlantoaxial joint. The patient demographics, surgery time, blood loss, bone fusion time, follow-up period, and surgery-related complications were meticulously documented. The mean follow-up duration was 35.1 ± 11.5 months. Complete reduction was achieved in 8 patients, while one patient did not achieve complete reduction. The ADI decreased significantly from 8.7 ± 2.2 mm before surgery to 2.1 ± 1.3 mm at the final follow-up. All patients demonstrated successful bone fusion, with an average fusion period of 3.7 ± 1.3 months. The Visual Analog Scale for Neck Pain at the final follow-up exhibited a significant decrease compared with preoperative values (P < .05), while no significant difference was observed in Japanese Orthopaedic Association scores. There were no complications related to surgery. Posterior atlantoaxial release, reduction, and intra-articular fusion with a C2 nerve root preservation technique is effective in the treatment of irreducible type III AARF.

Increase of pyogenic bacterial infections after relaxation of social distancing measures linked to COVID-19 pandemic.

After the relaxation of COVID-19 mitigation measures, we observed a dramatic increase in pyogenic infections. Based on this observation, we retrospectively analysed all cases of invasive bacterial infections of brain, lung and complicated ear-nose-throat (ENT) infections, in the period from 1 August to 31 March from the years 2018-2019 to 2022-2023. The study was conducted in two Paediatric Emergency Departments, at IRCCS 'Burlo Garofolo' of Trieste and at Treviso Hospital. Electronic medical records were searched for all cases with a definitive diagnosis at discharge of mastoiditis, suppurative cervical lymphadenitis, retropharyngeal, parapharyngeal and peritonsillar abscess (ENT group), bacterial brain abscesses, epidural empyema, subdural empyema (central nervous system group), thoracic empyema and necrotising pneumonia (lung group). In 2022-2023, we observed an increase in infections compared to the previous years. Total number of cases were 22, 29, 8, 27 and 63 in 2018-2019, 2019-2020, 2020-2021, 2021-2022 and 2022-2023, respectively. The greater increase occurred in thoracic empyema, with a peak incidence of +120% in 2022-2023 in respect of 2021-2022. We reported an important increase in paediatric bacterial complicated infections in two North East Italian regions, possibly correlated with the relaxation of COVID-19 social distancing measures.

Retropharyngeal Abscess Complicated by Mediastinitis in Infants

Introduction: 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. Methods: 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. Results: 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. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA 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 paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases. Conclusion: Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging 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 h to medical management.

Conservative management of complicated retropharyngeal abscess with Antitubercular Therapy

Retropharyngeal abscess, the infection of deep neck spaces, extends from the base of the skull to the posterior mediastinum. It develops as a sequela of dental infection, upper respiratory tract infection, or any interventional procedure like laryngoscopy, endotracheal intubation, etc. Retropharyngeal abscess is a rare presentation of Tuberculosis (TB), with an annual incidence rate of 2.64 per 100,000 population, and gender-based incidence rates of 3.34 for males, and 1.94 for females per 100,000 population.1 It, as a part of head and neck TB, has a prevalence of 0.1-1% among all forms of TB. If not managed timely, it may lead to the spread of its infection to the mediastinum, which can be life-threatening at times, owing to airway compromission and other catastrophic complications like mediastinitis, mediastinal abscess, pericarditis, pyopneumothorax pleuritis and empyema. We hereby present a case of a middle-aged woman diagnosed with a complicated retropharyngeal abscess but managed conservatively with Antitubercular Therapy (ATT).

Fungal necrotizing external otitis complicated by a retropharyngeal abscess in a diabetic patient: a case report

Fungal necrotizing external otitis complicated by a retropharyngeal abscess in a diabetic patient: a case report

Cervical Pott's Disease Presenting as a Large Retropharyngeal Abscess: A Rare Case Report

Cervical Pott's Disease Presenting as a Large Retropharyngeal Abscess: A Rare Case Report

An assessment of radiology resident competency in identifying suppurative retropharyngeal lymphadenitis: an examination using the WIDI SIM platform.

Suppurative retropharyngeal lymphadenitis is a retropharyngeal space infection almost exclusively seen in the young (4-8years old) pediatric population. It can be misdiagnosed as a retropharyngeal abscess, leading to unnecessary invasive treatment procedures. This retrospective study aims to assess radiology residents' ability to independently identify CT imaging findings and make a definitive diagnosis of suppurative retropharyngeal lymphadenitis in a simulated call environment. The Wisdom in Diagnostic Imaging Emergent/Critical Care Radiology Simulation (WIDI SIM) is a computer-aided emergency imaging simulation proven to be a reliable method for assessing resident preparedness for independent radiology call. The simulation included 65 cases across various imaging modalities of varying complexity, including normal studies, with one case specifically targeting suppurative retropharyngeal adenitis identification. Residents' free text responses were manually scored by faculty members using a standardized grading rubric, with errors subsequently classified by type. A total of 543 radiology residents were tested in three separate years on the imaging findings of suppurative retropharyngeal lymphadenitis using the Wisdom in Diagnostic Imaging simulation web-based testing platform. Suppurative retropharyngeal lymphadenitis was consistently underdiagnosed by radiology residents being tested for call readiness irrespective of the numbers of years in training. On average, only 3.5% of radiology residents were able to correctly identify suppurative retropharyngeal lymphadenitis on a contrast-enhanced computed tomography (CT). Our findings underscore a potential gap in radiology residency training related to the accurate identification of suppurative retropharyngeal lymphadenitis, highlighting the potential need for enhanced educational efforts in this area.

A rare case of disseminated tuberculosis presenting as multiple visceral abscesses: retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess

Extrapulmonary TB can present with plethora of clinical signs and symptoms, the spectrum of which remains boundless. Retropharyngeal abscess, epidural abscess, splenic abscess, hepatic granuloma are rare presentations of extrapulmonary TB which requires paramount clinical expertise for diagnosis and timely management thereby preventing dangerous complications. Here is a case report of a 6 year old boy presenting with 2 months history of fever, neck pain and swelling, difficulty in swallowing solid food, restricted neck movements, weight loss and family history of TB contact. Examination revealed bilateral jugulodigastric (level I and II) cervical lymphadenopathy (around 2×2 cm), neck rigidity and a paramedian bulge over posterior pharyngeal wall (measuring 3×3 cm), the inferior extent of which was difficult to visualize on oral cavity examination. Patient was worked up keeping in mind the high possibility of TB, radiography and ultrasonography of neck confirmed the presence of retropharyngeal abscess. CECT neck, chest and abdomen was done to find the extent of lesion and to look any other evidence of tuberculosis which revealed presence of retropharyngeal abscess, epidural abscess, pulmonary Koch’s, hepatic granuloma and splenic abscess with features s/o tuberculosis. He was started on ATT on clinico-radiological basis, his abscess was drained and cheesy material and pus were sent for microbiological and histo-pathological examination, although microbiological evidence was non-contributory, histopathology confirmed tuberculous retropharyngeal abscess. This case reporting was done to elicit the rare presentation of EPTB and the need of high degree of clinical suspicion for early diagnosis and timely treatment to prevent future complications.

Clivus Osteomyelitis as a Complication of Retropharyngeal Abscess in an Immunocompetent Adolescent.

Clivus Osteomyelitis as a Complication of Retropharyngeal Abscess in an Immunocompetent Adolescent.

Deadly Retropharyngeal Abscess With Concurrent COVID-19 Infection: A Case Report

Retropharyngeal abscess is life-threatening with potential airway emergency. A 53-year-old lady with diabetes mellitus presented with diffuse painful neck swelling for a week and difficulty in breathing with stridor. Video laryngoscopy done in operating theatre showed edematous laryngeal inlets with bulging posterior pharyngeal wall. Patient was tested positive for COVID-19 infection. The management was taken with high precautions, careful planning with unconventional and multidisciplinary approach. Management included airway protection, antibiotic, surgical drainage and correction of hyperglycaemia besides the compliance to COVID-19 SOP. Prognosis is good if identified early, managed aggressively and complications are avoided albeit the comorbidity and COVID-19 infective status.

Swallowing the Unexpected: A Case Report on an Unusual Presentation of Esophageal Malignancy.

Head and neck malignancies presenting with a neck abscess as the primary symptom are uncommon and may result in a misdiagnosis or delay in diagnosis and appropriate treatment. Here we report on a rare case where a young adult presented with signs and symptoms of a retropharyngeal abscess, which was later identified as an esophageal malignancy.

Incomplete Kawasaki Disease Presenting as Retropharyngeal Abscess: A Case Report and Review of the Literature.

Kawasaki disease (KD) is a cryptic and self-limiting vasculitis predominantly seen in children, often posing a diagnostic challenge due to its varied clinical presentations. Among these, the emergence of deep neck infections, particularly retropharyngeal abscesses, stands out as an extremely rare manifestation. Herein, we present a case of a 10-year-old girl who was hospitalized for fever, neck pain, swollen cervical lymph nodes, and increased inflammation markers. Although anti-infective treatment was initiated, her condition remained unchanged. A cervical computed tomography scan revealed an abscess in the retropharyngeal space. Remarkably, on the third day post-admission, the patient developed symptoms synonymous with KD, such as conjunctival redness, reddened lips, and a strawberry tongue. Subsequent treatment with high-dose intravenous immunoglobulins (IVIG) and oral aspirin led to swift symptom relief, including complete abscess resolution verified by a follow-up neck magnetic resonance imaging. This unique co-presentation of KD and a retropharyngeal abscess, possibly linked to infections like Streptococcus or Staphylococcus aureus, underscores the importance of quick diagnosis and KD management, especially when conventional treatments prove ineffective.

Demographic disparities in children with retropharyngeal and parapharyngeal abscesses

PurposeTo explore the impact that demographic and socioeconomic factors such as age, gender, race, and insurance status have on the diagnosis of retropharyngeal (RPA) and parapharyngeal abscesses (PPA) in the pediatric population. MethodsThe 2016 HCUP KID was searched for all RPA/PPA discharges using the joint ICD-10 code J39.0. Descriptive statistics, univariate, and multivariate analyses were performed to assess the relationship between demographic factors and their impact on RPA/PPA diagnosis. Results were reported with their corresponding odds ratio with a 95 % confidence interval and p-value. Results56.4 per 100,000 weighted discharges were discharged with a diagnosis of a RPA/PPA, the average age was 5.7 years old, with a male predominance. Pediatric discharges diagnosed with a RPA/PPA were less likely to identify as Hispanic or Asian/Island Pacific. They were also less likely to be insured by Medicaid and reside in zip codes with a lower median income. ConclusionThe analysis of this national pediatric database demonstrated significant demographic differences in children diagnosed with RPA/PPAs. Following the multivariate analysis, children from a higher socioeconomic background and those with private insurance were more likely to be diagnosed with a RPA/PPAs. However, disparities in children's overall hospital course and complications is a potential area for future research.

Hypopharyngeal foreign body impaction presenting late as acute onset torticollis due to retropharyngeal abscess formation in a child

No abstract available

1683. Severe Group A Streptococcus Infections Amongst Pediatric Patients in the Lehigh Valley, Pennsylvania Following the COVID-19 Pandemic

Abstract Background In December 2022 the CDC issued an alert about possible increase of invasive group A Streptococcus infections (iGAS) among children in the United States. Colorado and Minnesota observed an increase in the number of cases in the Fall 2022. Similarly, the Pennsylvania Department of Health issued a health alert that was then lifted in February 2023. Preliminary CDC data showed that iGAS infections were higher in some areas of the country compared to pre-pandemic levels. Lehigh Valley Reilly Children’s Hospital is a community teaching hospital in Allentown, Pennsylvania. A rise in the number of children admitted with GAS infections was noted in the same period compared to previous years. The aim of our study was to determine the clinical characteristics of patients admitted with iGAS and non-iGAS infections during fall and winter 2022-2023. Methods Retrospective chart review of patients 18 years and younger admitted to Reilly Children’s Hospital between September 1st 2022 through March 31st 2023 and diagnosed with GAS infection plus those admitted with the same diagnosis between 2018 and 2022. Results There were 19 children admitted to the hospital with GAS infection: 6 (32%) with iGAS and 13 (68 %) with non-iGAS infections. The iGAS infections included bacteremia without source (2), myositis (1), pneumonia (2), and vascular infection (1). Non-iGAS infections included retropharyngeal abscess (3), peritonsillar abscess (2), parotid abscess (1), submandibular abscess (1), lymphadenitis (2), mastoiditis (1), cellulitis (1), pharyngitis (1), and erythema nodosum (1). Six children required intensive care and two were transferred to higher level care. Median age was 2.2 year for iGAS infections and 4.8 years for non-iGAS. All but one patient had no underlying medical conditions. There were no patient deaths. In 2018 there were zero cases of iGAS infection; in 2019: two cases; 2020: two cases; 2021: zero cases. There were no admissions between May 2020 and April 2022 for either iGAS or non-iGAS. Conclusion The number of children admitted for iGAS and non-iGAS infections in the fall and winter of 2022-2023 surpassed the preceding 4 years combined. This is reflective of what was happening in some other areas of the country as a result of reduced exposure and lack of immunity due to pandemic restrictions. Disclosures All Authors: No reported disclosures

Effective management of a retropharyngeal abscess using endoscopic complete-layer resection and drainage.

Effective management of a retropharyngeal abscess using endoscopic complete-layer resection and drainage.

Odynophagia in individuals with neck pain: the importance of differential diagnosis in physiotherapy practice.

Odynophagia refers to painful swallowing caused by various underlying factors that must be excluded to determine the best treatment approach. Neck pain is a debilitating condition requiring treatment in rehabilitative settings. There are several circumstances in which odynophagia and neck pain coexist, such as tendinitis of the longus colli muscle and paravertebral calcification, prevertebral and retropharyngeal abscess, esophageal perforation, aortic dissection, thyroid cartilage fracture, thyrohyoid ligament syndrome, pneumomediastinum and subcutaneous emphysema, and after physical exercise. Physiotherapists are professionals most likely to encounter individuals with neck pain and provide interventions such as massage, manual therapy, exercise, and electrotherapy. Therefore, it is important to recognize that neck pain can stem from different clinical conditions that require interventions other than physiotherapy. A differential diagnosis is crucial to ensure appropriate referrals for therapeutic interventions.

Descending necrotizing mediastinitis secondary to retropharyngeal abscess

We report a case of descending necrotizing mediastinitis (DNM) in a 68-year-old male who presented in acute respiratory distress accompanied with anterior cervical neck swelling and pain with swallowing. Contrast enhanced computed tomography (CECT) of the neck demonstrated a large, peripherally enhancing retropharyngeal fluid and air collection that appeared to communicate with a fluid and air collection within the mediastinum. CECT of the chest demonstrated punctate foci of air and fat stranding along the anterior and superior mediastinum. Radiological evidence and the presence of necrosis on surgical debridement of the retropharyngeal abscess established the diagnosis of DNM. This case emphasizes the role of computed tomography (CT) in the diagnosis of DNM and demonstrates the utility of chest imaging in a high-risk patient who presents with a retropharyngeal abscess.