Atypical locations of retropharyngeal abscess: beware of the normal lateral soft tissue neck X-ray.
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Affiliation
Otolaryngology Dept., Our Ladys Children Hospital Crumlin, Dublin 12, Ireland., uzomefuna@live.ieIssue Date
2012-02-01T10:24:19ZMeSH
Child, PreschoolDiagnosis, Differential
Humans
Male
*Neck/radiography
Retropharyngeal Abscess/diagnosis/*radiography
*Tomography, X-Ray Computed
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Int J Pediatr Otorhinolaryngol. 2010 Dec;74(12):1445-8. Epub 2010 Oct 15.Journal
International journal of pediatric otorhinolaryngologyDOI
10.1016/j.ijporl.2010.09.008PubMed ID
20951442Abstract
Retropharyngeal abscesses (RPA) are uncommon but potentially lethal deep neck space infections, over 95% of which occur in children under six years of age. Without a high index of suspicion, early recognition and prompt intervention, catastrophic consequences can ensue, and mortality can be as high as 60% if jugular vein thrombosis or mediastinitis occurs. While older children may have specific complaints referable to the pharynx, infants and young children may present with vague symptoms. To date, a lot of emphasis continues to be placed on the importance of lateral soft tissue neck X-ray in the diagnosis and management of patients with suspected retropharyngeal abscesses; and lateral neck X-ray has been cited as the most useful radiological view of the laryngopharynx. While we recognise the role of lateral neck X-rays in retropharyngeal and other upper airway pathologies, we present three case series in which lateral neck X-rays were normal and diagnosis was made only after CT scanning. These three cases were unusual as the abscesses were located high in the naso-pharynx making them impossible to detect on the lateral soft tissue neck X-rays and this underscores the need for high index of suspicion and prompt CT or MRI scanning, in any child with symptoms or signs suggestive of a possible retropharyngeal abscess.Language
engISSN
1872-8464 (Electronic)0165-5876 (Linking)
ae974a485f413a2113503eed53cd6c53
10.1016/j.ijporl.2010.09.008