This is a lateral neck Xray of a Woman came to the ENT clinic complaining of  High fever, Odynophagia(pain during swallowing) and neck pain for 4 days duration.Further questioning on that woman doctor was able to reveal that she  had removed fish bone stuck in her throat about 3weeks ago.
Comment on this Xray?




ANSWER

Answer - Retropharyngeal abscess
ARetropharyngeal abscess is usually seen in infants or young children.
The retropharyngeal space is posterior to the pharynx, bound by the buccopharyngeal fascia anteriorly, the prevertebral fascia posteriorly.
It is a potentially life-threatening medical condition.
The abscess is limited to one side of the midline.This is because of the intervening median raphe of the bucco-pharyngeal fascia which is firmly attached to the pre-vertebral fascia.
Causes
* Upper respiratory tract infection
* Oral infections
* Pharyngeal trauma from endotracheal intubation,endoscopy, foreign body ingestion

CLINICAL FEATURES

Symptoms
  • Breathing difficulty
  • Difficulty swallowing(Dysphagia)
  • Painfull swallowing (Odynophagia)
  • Drooling of saliva
  • High fever
  • Stridor
  • Intercostal retractions
  • Sore throat
Signs
  • Posterior pharyngeal edema
  • Nuchal rigidity
  • Cervical adenopathy
  • Stridor

INVESTIGATIONS

* Full Blood Count
* Blood cultures
* C-reactive protein
* Lateral Neck Xray


Widening of the retropharyngeal soft tissues
Widening of the prevertebral space
Gas in the tissues
Straightening of cervical vertebrae


* Contrast CT scan of the neck - Retropharyngeal abscess appears as a hypodense lesion in the retropharyngeal space with peripheral ring enhancement.
* Chest XRAY - To exclude aspirational pneumonia and mediastinitis

COMPLICATIONS

Possible Complications


1. Airway obstruction
2. Aspiration pneumonia
3. Mediastinitis
4. Osteomyelitis
5. Epidural abscess
6. Jugular venous thrombosis
7. Necrotizing fasciitis
8. Sepsis

TREATMENT

1. Airway management if upper airway obstruction is present
2. Surgery is needed to drain the infected area
3. IV Antibiotics - Gram-positive organisms , gram-negative organisms, and anaerobes must be covered
4. Corticosteroids are sometimes given to reduce airway swelling





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9 comments

  1. macho man Says:
  2. retro pharyngeal abscess

     
  3. student0112 Says:
  4. Retropharyngeal abscess. The fishbone has damaged the posterior pharyngeal wall leading to infection of the retropharyngeal space. Soft tissue lateral view neck shows increase in prevertebral space, presence of gas and straightening of cervical vertebrae.

     
  5. RETROPHARYNGEAL ABSCESS
    x-ray shows increase prevertebral space with gas shawdow.

     
  6. Anonymous Says:
  7. arash from iran
    parapharyngeal or retropharyngeal abscess
    i think there is a abnormal density in tracheal shadow , maybe perforation of esophagus or infection involvement around trachea
    what is the answer

     
  8. Anonymous Says:
  9. arash from iran
    please tell us correct diagnosis

     
  10. Anonymous Says:
  11. And the answer is?

     
  12. Anonymous Says:
  13. what is the diagnosis?

     
  14. Tapas_09 Says:
  15. I think it is...

    Rrtropharyngeal abscess

     
  16. Anonymous Says:
  17. The diagnosis is simply placed on the history even before viewing the x-ray, However, the x-ray is also a spot diagnosis of retropharyngeal abscess.

    anm

     

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