Atypical locations of retropharyngeal abscess: beware of the normal lateral soft tissue neck X-ray.
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.
Otolaryngology Dept., Our Ladys Children Hospital Crumlin, Dublin 12, Ireland. uzomefuna@live.ie
Vincent
V
Uzomefuna
Fergal
F
Glynn
Tara
T
Mackle
John
J
Russell
D002675:Child, Preschool; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D009333:Neck / Q000000981:diagnostic imaging; D017703:Retropharyngeal Abscess / Q000175:diagnosis / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed