Retropharyngeal Abscess Research Articles

Fusobacterial Infections in Children

Fusobacteria are members of the oral and gastrointestinal flora and are important potential pathogens in children. They are increasingly recognized as a cause of infections in children. These include infections of the head and neck (Lemierre syndrome, acute and chronic mastoiditis, chronic otitis and sinusitis, tonsillitis, peritonsillar and retropharyngeal abscesses, postanginal cervical lymphadenitis, periodontitis), brain, lungs, abdomen, pelvis, bones, joints, and blood. This review describes the clinical spectrum of fusobacterial infection in children and their management.

Retropharyngeal abscess: An unusual presentation of Kawasaki disease. Case report and review of the literature

Retropharyngeal abscess: An unusual presentation of Kawasaki disease. Case report and review of the literature

Incidence of Retropharyngeal Calcific Tendinitis (Longus Colli Tendinitis) in the General Population

To determine the incidence of retropharyngeal calcific tendinitis (longus colli tendinitis) in a general urban adult population. Observational study in a municipal medical center. Single tertiary referral center. All symptomatic patients with a differential diagnosis of retropharyngeal calcific tendinitis underwent fiber-optic assessment, laboratory studies, and imaging studies. The main outcome measure was the incidence of retropharyngeal calcific tendinitis. Thirteen patients with symptoms suggestive of retropharyngeal calcific tendinitis were evaluated in our institution between January 2008 and December 2011. Final diagnosis was made by means of a computed tomographic scan: 8 patients had retropharyngeal calcific tendinitis, 1 had retropharyngeal abscess, and the remaining 4 had other deep neck infections. The mean annual crude retropharyngeal calcific tendinitis incidence was 0.50 cases per 100,000 person-years, and the standardized incidence was 1.31 for the age-matched population. Retropharyngeal calcific tendinitis is not a rare disease and is probably underdiagnosed because symptoms are nonspecific, treating physicians are often unfamiliar with this entity, and it is a self-limiting pathology.

A Case of Calcific Retropharyngeal Tendinitis: The Significance of an Early Diagnosis

The clinical presentation of calcific retropharyngeal tendinitis, a rare entity, can mimic more serious disorders. We describe the case of a 35-year-old man who was referred to us for evaluation of a suspected retropharyngeal abscess. At presentation, the patient reported severe cervical pain and stiffness. He exhibited mild fever, torticollis, and a moderately elevated white blood count; no swelling of the retropharyngeal wall was observed. Based on the results of plain radiography and computed tomography (CT), we diagnosed the patient with calcific retropharyngeal tendinitis. He was treated with a 7-day course of a nonsteroidal anti-inflammatory drug and a 3-day course of a steroid, and he recovered well. We suggest that the true incidence of calcific retropharyngeal tendinitis is actually higher than what is generally believed because this diagnosis is frequently missed. Contrast-enhanced CT can aid in diagnosing calcific retropharyngeal tendinitis. CT should be performed in patients who present with nonspecific symptoms such as severe neck pain, sore throat, odynophagia, and mild fever.

Early descriptions of Grisel's syndrome

Dear Editor: We read with great interest the comprehensive review paper of Osiro et al. presenting Grisel's syndrome [1]. Apart from the introduction of this rare syndrome, the authors discussed recent developments on the pathogenesis of the syndrome along with treatment options. In the introduction, Sir Charles Bell (1774–1842 CE) was introduced as the first to explain nontraumatic atlantoaxial subluxation due to pharyngitis which ultimately led to death of the patient from spinal cord compression [1, 2]. Grisel's syndrome was named after Pierre Grisel (1869–1959 CE), a French surgeon who described the syndrome characterized by dislocation of the C1–C2 joint mostly in patients with pharyngitis and torticollis [1, 3]. Based on the historical evidence, we believe that the syndrome was known to the Greek and Persian physicians much earlier than thought. Among the ancient Greek scholars, Aetius of Amida (fifth–sixth century of the Common Era) seems to be the first to indicate the association between inflammation of the vertebrae caused by retropharyngeal abscess and vertebral luxation in his section on diphtheria [4]. The syndrome was later described by Rhazes (865–925 CE) in his Kitab al-Hawi (Liber Continens) quoting from Hippocrates' Of The Epidemics [5]. In the tenth century of the Common Era, Akhawayni Bukhari (Fig. 1), a prominent Persian physician, compiled the oldest extant treatise on medicine in new Persian, Hidayat al-Muta`allemin fi al-Tibb (The Students' Handbook of Medicine) [6, 7]. Being relatively short and simplified, the Hidayat was dedicated to the author's son and other students of medicine [8]. The second part of the book contains a chapter on the diphtheria describing different etiologies of suffocation, with a particular emphasis on a complication associated with neck pain and anterior subluxation of the cervical vertebrae. In addition to his description of this clinical entity, Akhawayni recommends novel life-saving approaches to the disease. Briefly, he advised application of either tongs or especially designed reins for applying pressure to reduce the subluxated vertebra [9]. The disease appears in the medical writings of the following centuries such as Avicenna's The Canon of Medicine and Jorjani's The Treasure of Khwarazm Shah, none of which have discussed the disease as detailed and instructive as that of Akhawayni's [10–12]. Altogether, descriptions of Grisel's syndrome and its associated symptoms are not limited to the recent centuries and date back to the earlier periods. S. E. J. Golzari Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Retropharyngeal abscess coinfected withStaphylococcus aureusandMycobacterium tuberculosisafter rhinoviral infection in a 1-month-old infant

A retropharyngeal abscess is a rare disease entity in young infants but can develop after nasopharyngeal viral infection. Group B Streptococcus and Staphylococcus aureus are the most common pathogens in young infants, however, Mycobacterium tuberculosis is very rare. We report the case of retropharyngeal abscess and coinfection with S. aureus and M. tuberculosis in a very young infant presenting with respiratory symptoms due to upper airway obstruction. Usually tuberculous retropharyngeal abscesses are caused by the direct invasion of the bacteria from the spine via anterior longitudinal ligament of the spine. However, in this case, no associated spinal disease was observed.

Giant Retropharyngeal Abscess in a Nigerian Adult Following Fish Bone Throat Injury

Retropharyngeal abscess (RPA) is an uncommon disease entity that typically occurs in children under 5 years of age, which has the potential to cause upper airway obstruction. Upper respiratory tract infection is the most common predisposing factor to RPA in children while cervical spine tuberculosis and trauma are the major aetiological factors in the adult. We report a case of a 21-year-old Nigerian farmer with giant retropharyngeal abscess following fish bone throat injury causing life-threatening upper airway obstruction. The patient responded well to emergency tracheostomy, intraoral surgical drainage and empirical antibiotic therapy. We highlight the diagnostic and therapeutic challenges of managing such a patient.

Retropharyngeal Abscess: Its Evolution and Imaging Assessment

This was followed by multiplanar multisequence MRI with and without Gadolinium performed at day 5 which confirmed the central necrosis of retropharyngeal adenopathy with peripheral restricted diffusion (Figures 2a-2d). Significant surrounding soft tissue enhancement was seen indicative of phlegmon. In addition, MRI confirmed the presence of non-occlusive thrombosis in the right transverse and sigmoid sinuses and extension into the upper jugular vein (Figures 2e and 2f).

Susceptibility and emm type of Streptococcus pyogenes isolated from children with severe infection

Minimal inhibitory concentrations (MICs) and minimal bactericidal concentrations (MBCs) of various antimicrobial agents were measured against 12 strains of Streptococcus pyogenes isolated from children with invasive infections between 2003 and 2012. The patients ranged in age from 1 day to 15 years, with patients younger than 5 years, including three neonates, accounting for a half of the patients. The disease was sepsis in four patients, skin and soft tissue infection in three patients, retropharyngeal abscess in two patients, pneumonia plus sepsis in one patient, empyema in one patient, and pyogenic arthritis in one patient. One patient with sepsis died, while cure without sequelae was achieved in all the remaining patients. When classified by type, emm1 (six strains) was the most prevalent type, followed by emm12 (two strains). The MIC90/MBC90 values were 0.015/0.015 μg/mL for penicillin G, 0.03/0.03 μg/mL for ampicillin, 0.015/0.03 μg/mL for cefotaxime, 0.03/0.03 μg/mL for ceftriaxone, 0.008/0.008 μg/mL for panipenem, 0.008/0.008 μg/mL for meropenem, and ≤0.004/≤0.004 μg/mL for doripenem, indicating the superior antimicrobial activities of carbapenem.

石灰沈着性頸長筋腱炎の8例

Calcific retropharyngeal tendinitis/retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle caused by calcium hydroxyapatite crystal depositon in the longus colli muscle tendon. The three major symptoms are neck pain, limitations of neck movement, and swallowing pain. We treated 8 cases of calcific retropharyngeal tendinitis/ retropharyngeal calcific tendinitis. Each patient complained of neck pain, limitations of neck movement, and swallowing pain. The only local finding was the smooth swelling of the posterior pharyngeal wall. CT imaging showed calcification of the tendon of the longus colli muscle and a low density area in the retropharyngeal space without ring enhancement, suggesting a retropharyngeal abscess. MR imaging showed the smooth swelling of the retropharyngeal space and an increased signal intensity on T2-weighted MR imaging. Calcific retropharyngeal tendinitis heals spontaneously, and treatment is not usually required. However, the clinical outcomes are similar and can be confused with retropharyngeal abscess and pyogenic spondylitis, so antibiotics are administrated in many cases. In our report, 7 patients were hospitalized and were treated with the intravenous administration of antibiotics, while 1 patient who refused hospitalization was treated with an oral antibiotic. Steroids were administrated in 2 cases. The 7 patients who were hospitalized were cured within 6 to 10 days.

Retropharyngeal Calcific Tendinitis Mimicking a Retropharyngeal Phlegmon

Background. Acute retropharyngeal tendinitis is a little known but not an uncommon condition. It was first described by Hartley in 1964 as an inflammation of the longus colli muscle secondary to calcium crystals deposition on its insertion. The calcifications are mostly located on the oblique portion of the muscle at the level of C1-C2. Methods. We will describe this disease through 4 cases that presented in our institution. Results. The most common symptoms are severe neck pain, odynophagia, and a painful restriction of neck movement. It is associated with mild fever and inflammatory lab findings such as a slight elevation of white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. CT scan is recommended as the first-line imaging modality to establish a diagnosis. Treatments consist of NSAIDs and analgesics to accelerate the healing process. If symptoms are severe, a course of corticosteroids is required. Conclusion. Since the clinical and laboratory findings of this condition and those of a retropharyngeal abscess overlap, it is important to establish the right diagnosis in order to prevent more invasive procedures. A good knowledge of this clinical entity by otolaryngologists would prevent delays in hospital discharge and unnecessary anxiety.

Paediatric acute retropharyngeal abscesses: An experience

To describe our experience of paediatric patients with acute retropharyngeal abscess in terms of clinical presentation, diagnosis, management and complications. A prospective study was done for a period of 4 years (Jan 2009 to Jan 2013) on paediatric patients (< 15 years) with acute retropharyngeal abscess at two tertiary hospitals in Srinagar. Diagnosis was made on the basis of X-ray, CECT scan findings and confirmed on incision and drainage. Pus was aspirated from all patients and sent for culture and sensitivity. Data for clinical presentation, X-ray, CECT scan findings, causes, complications, bacteriology and management were collected. Thirty-five abscesses were drained while 5 with small abscesses on CECT were managed conservatively. A total of 40 patients were diagnosed as acute retropharyngeal abscesses. Males were commonly affected, and most of the patients were less than 6 years of age. Most common symptom at presentation was fever (35) followed by neck pain (30) Dysphagia/odynophagia (22), swelling in neck (19). Most common clinical sign observed was oropharyngeal swelling and limitation of neck movements (30), cervical swelling/lymphadenopathy in 22 patients. Torticollosis and drooling were seen in 15 patients. Complications were seen in 8 patients. Most common X-ray finding was pre-vertebral thickening. Success rate with primary surgical drainage was 95% while 3 patients in conservative group failed. Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Surgical intervention is necessary for most of these patients.

Retropharyngeal Calcific Tendonitis Mimics a Retropharyngeal Abscess

Retropharyngeal calcific tendonitis (RCT) is an uncommon, self-limiting condition that is often omitted in the differential diagnosis of a retropharyngeal fluid collection. This condition mimics a retropharyngeal abscess and should be considered when evaluating a fluid collection in the retropharyngeal space. Although calcific tendonitis at other sites has been well described in the medical literature, it appears that this entity has been underreported in the otolaryngology literature where only a few case reports have been identified. Presumably, the actual incidence is higher than the reported incidence, due to lack of familiarity with this disorder. As an otolaryngologist's scope of practice includes the managements of retropharyngeal lesions, it is important for the otolaryngologist to recognize the presentation of acute RCT and be familiar with appropriate treatment strategies. Retropharyngeal calcific tendonitis presents with neck pain, limitation of neck range of motion and includes inflammation, calcifications, and a sterile effusion within the longus colli muscle. Treatment is medical with nonsteroidal anti-inflammatory medications. RCT does not require surgical treatment, and an accurate diagnosis can prevent unnecessary attempts at operative drainage. In this study, we discuss two cases of RCT, summarize the salient features in diagnosis, including key radiologic features, discuss treatment options, and review the literature.

Retropharyngeal Abscess Due to Actinomyces Species in an Immunocompromised Patient: Case Report

Actinomyces are fastidious, obligate anaerobic grampositive bacilli that are non–acid fast and slow growing. These characteristics make the organism difficult to identify by routine specimen handling and routine culture techniques. Nineteenth-century investigators originally characterized the organism as a fungus because it forms large radiating colonies, hence its name. This organism is widely accepted to be part of the normal flora in the abdominopelvic and thoracic regions but is most commonly found in the cervicofacial area. Cervicofacial actinomycosis usually presents as a firm, non-painful, slowly progressive swelling, with multiple sinus tracts in the periodontal soft tissue areas, maxilla, mandible, tongue, submandibular gland, or neck. Because Actinomyces are present as commensal organisms in healthy humans, they are best thought of as opportunistic pathogens. The organism does not cross mucosal barriers except when there is tissue injury or in an immunocompromised condition. Actinomyces are exquisitely sensitive to penicillin. Retropharyngeal abscesses due to Actinomyces spp are rare and found only in isolated case reports.

Retropharyngeal cold abscess without Pott’s spine

Retropharyngeal abscesses are infections deep in the neck space that can pose an immediate life-threatening emergency, with potential for airway compromise and other catastrophic complications. In adults these abscesses can develop as a result of vertebral pyogenic osteomyelitis, tuberculosis of the spine, or external injuries caused by endoscopes or foreign bodies (e.g. fish bones). Tuberculosis of the retropharyngeal space is one of the rare forms of extrapulmonary tuberculosis. Early diagnosis and treatment are necessary to prevent the serious complications of the disease. We present a case of tuberculous retropharyngeal abscess in an adult woman without tuberculosis of the cervical spine who was managed surgically by aspirating the retropharyngeal abscess transorally, together with antituberculosis treatment.

Chronic retropharyngeal abscess

Introduction: Chronic retropharyngeal abscess can occur in the adults as well as in children. It is usually due to tuberculous infection of the cervical spine as the pus directly spreads through the anterior longitudinal ligament into the retropharyngeal space. Case report: We report a case of chronic retropharyngeal abscess in a 60-year-old woman who presented with throat pain and dysphagia. On examination there was bulging of the posterior pharyngeal wall and also right sided neck swelling. She was treated by external drainage of abscess under local anaesthesia and she recovered well with anti-tubercular drugs DOI: http://dx.doi.org/10.3329/bjo.v18i2.12032 Bangladesh J Otorhinolaryngol 2012; 18(2): 242-244

Acute calcific tendinitis of the longus colli muscle: case report and review of the literature

Acute calcific tendinitis of the longus colli muscle (or retropharyngeal tendinitis) is an aseptic inflammatory process characterized by acute posterior neck pain, neck stiffness and dysphagia or odynophagia. Awareness of its existence is crucial in the differential diagnosis, because many other conditions, such as retropharyngeal abscess, meningitis or disc herniation, show similar clinical features. We present a case exhibiting an uncommon symptom (torticollis) and a brief literature review to emphasize the risk of misdiagnosis. A 36-year-old woman presented with neck stiffness and torticollis accompanied by dysphagia and prevertebral space sensitivity on the second day. The diagnosis was established by computed tomography (CT), the gold standard for identifying the presence of prevertebral oedema and calcific deposition associated with retropharyngeal tendinitis. Treatment with NSAIDs and low doses of corticosteroids relieved the symptoms within 48 h. Retropharyngeal tendinitis is an underreported entity in the literature and orthopaedists should become aware of its existence. Misdiagnosis of this important mimicker may lead to unnecessary antibiotics administration and interventions in the retropharyngeal space.

To drain or not to drain – Management of pediatric deep neck abscesses: A case–control study

Optimal management of deep neck abscesses has been the subject of debate for more than a century: surgical drainage has been the mainstay of treatment, but recently many centres have reported successful non-operative management in selected cases. ObjectivesOur objective was to review the management of deep neck abscesses in our institution and to identify characteristics that would predict successful non-operative management. MethodsA retrospective chart review from January 2001 to August 2010 was performed. Children up to age fifteen years with a CT-confirmed diagnosis of retropharyngeal or parapharyngeal abscess were included. A case–control study of small deep space neck abscesses (≤25mm maximal diameter) was performed, comparing antibiotic treatment alone with antibiotics plus abscess drainage. Results54 children met the inclusion criteria, of whom half had abscesses ≤25mm diameter. Younger children within the group with smaller abscesses were more likely to need surgical drainage (p<0.05). Of 13 children requiring operative management, ten underwent a period of antibiotic treatment and observation prior to surgery, eight (80%) had fever beyond 48h compared with three (23%) in the non-surgical group (p<0.01).27 children had an abscess >25mm diameter on CT scan, four (15%) of whom responded quickly to antibiotics and were managed non-operatively, while the rest underwent surgery. There were no significant differences between the surgical and non-surgical group characteristics with larger abscesses. ConclusionHigh dose intravenous antibiotics are an effective treatment for deep space neck abscesses and may obviate the need for surgical drainage, particularly in smaller abscesses. Children who do not respond quickly to antibiotics are more likely to require surgery to achieve resolution. Children with larger abscesses may respond to antibiotic therapy alone but should be closely observed. A trial of high dose intravenous antibiotics in stable children with close observation is warranted as first line treatment, especially for small deep space neck abscesses.

Tuberculous retropharyngeal abscess presenting with symptoms of obstructive sleep apnea

Chronic retropharyngeal abscess (RPA) caused by tuberculosis is an uncommon manifestation of extrapulmonary tuberculosis within the head and neck. Obstructive sleep apnea (OSA) in adults is a common condition with many etiologies that have been well described. Here, we present a case of retropharyngeal abscess caused by chronic tuberculosis with an unusual and interesting presenting symptom in an adult that has not been mentioned in literature, new-onset and worsening stertor or snoring, with signs and symptoms of OSA. The purpose of this manuscript is to present our experience with this case, as well as to emphasize the diagnosis, clinical course, and management of tuberculous retropharyngeal abscess in adults, while also signifying the need to include retropharyngeal abscess in the differential diagnosis for symptoms presenting as new-onset stertor and airway obstruction.

Rapidly progressing subperiosteal orbital abscess: an unexpected complication of a group-A streptococcal pharyngitis in a healthy young patient

IntroductionComplications associated to group-A streptococcal pharyingitis include non-suppurative complications such as acute rheumatic fever and glomerulonephritis and suppurative complications such as peritonsillar or retropharyngeal abscess, sinusitis, mastoiditis, otitis media, meningitis, brain abscess, or thrombosis of the intracranial venous sinuses.Case presentationWe described a case of a 15-year-old patient with a history of acute pharyngodinia early followed by improvise fever and a progressive formation of a diffuse orbital edema, corneal hyperaemia, diplopia and severe decrease of visual acuity.The patient was surgically treated with functional endoscopic sinus surgery (FESS) after the response of a maxillofacial computed tomography scans that showed a pansinusitis complicated by a left orbital cellulites. Numerous colonies of Streptococcus pyogenes were found in the samples of pus and an antibiotic therapy with meropenem was initiated on the basis of the sensitivity test to antibiotics. The patient was finally discharged with diagnosis of left orbital cellulites with periorbital abscess, endophtalmitis and acute pansinusitis as a consequence of streptococcal pharyngitis.ConclusionThe case highlights the possible unusual complication of a group-A streptococcal pharyingitis in a immunocompetent child and the needing of a prompt surgical and medical approach toward the maxillofacial complications associated to the infection.