What's the Diagnosis? By Dr. Lesley Walinchus-Foster
Wed, 02/13/2019 - 7:00am
Editor:
A 17 month old male with no past medical history presents to the ED with fever, L sided neck swelling, decreased PO intake and drooling x 1 day. His immunizations are UTD. A CT scan is obtained. What's the diagnosis? (scroll down for answer)
Answer: Retropharyngeal Abscess
- Causes:
- Suppuration of surrounding lymph nodes
- Localized penetrating trauma
- Instrumentation
- Ventral extension of vertebral osteomyelitis
- Signs and symptoms
- Neck pain/swelling
- Fever
- Dysphagia
- Excessive drooling
- Neck stiffness/torticollis/neck held in hyperextension
- Diagnosis:
- Radiograph findings: Retropharyngeal space at C2 = twice diameter of vertebral body OR Retropharyngeal space > 1/2 width of C4 vertebral body
- CT: limited ability to differentiate abscess vs. cellulitis/phlegmon
- Treatment:
- Monitor airway; stabilize if needed prior to interventions
- Minimize exams/noxious stimuli
- Small abscesses may be managed with antibiotics alone if patient stable; larger/unstable may require surgical intervention
- Common organisms: S. arueus, S. pyogenes, Streptococcus viridans, Beta-lactamase producing gram-negative rods
- Antibiotics: IV clindamycin or ampicillin/sulbactam
References:
Mapelli E, Sabhaney V. Stridor and Drooling in Infants and Children. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e New York, NY: McGraw-Hill; 2016