title: Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases.
abstract: OBJECTIVE
  This study was designed to analyse the contribution of CT scan to the management of retropharyngeal abscess in children and the place of CT-guided percutaneous aspiration as an alternative to surgical drainage.
  
  
  METHODS
  Retrospective study including 18 children with a mean age of 38 months [range: 5-67 months] presenting with retropharyngeal infection between 2006 and 2011. All cases were initially assessed by contrast-enhanced CT scan of the neck. Clinical, radiological treatment and bacteriological data were collected. Radiological results were correlated with surgical and percutaneous aspiration findings (presence or absence of an abscess).
  
  
  RESULTS
  The initial CT scan detected 14 abscesses, 3 cases of non-suppurative lymphadenitis and one case of retropharyngeal oedema. One case of non-suppurative lymphadenitis progressed to abscess after failure of antibiotic therapy and was treated surgically. Surgical drainage revealed a purulent collection in 11 cases and no collection in 3 cases. Four CT-guided percutaneous aspirations were successfully performed. Three cases were treated by antibiotics alone (2 cases of lymphadenitis and 1 case of retropharyngeal oedema). Bacteriological examinations revealed the presence of Streptococcus pyogenes in 78.5% of cases. The positive predictive value of the initial CT scan was 78.8% in our series.
  
  
  CONCLUSIONS
  Contrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48 hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage.
authors.affiliation: Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, Université d'Auvergne, CHU de Clermont-Ferrand, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: C A
authors.initials: CA
authors.lastname: Martin
authors.affiliation: Département de Neuroradiologie, hôpital Gabriel-Montpied, CHU de Clermont-Ferrand, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: J
authors.initials: J
authors.lastname: Gabrillargues
authors.affiliation: Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, Université d'Auvergne, CHU de Clermont-Ferrand, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: C
authors.initials: C
authors.lastname: Louvrier
authors.affiliation: Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, Université d'Auvergne, CHU de Clermont-Ferrand, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: N
authors.initials: N
authors.lastname: Saroul
authors.affiliation: Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, Université d'Auvergne, CHU de Clermont-Ferrand, rue Montalembert, 63000 Clermont-Ferrand, France.
authors.forename: T
authors.initials: T
authors.lastname: Mom
authors.affiliation: Service d'oto-rhino-laryngologie et chirurgie cervico-faciale, Université d'Auvergne, CHU de Clermont-Ferrand, rue Montalembert, 63000 Clermont-Ferrand, France. Electronic address: lgilain@chu-clermontferrand.fr.
authors.forename: L
authors.initials: L
authors.lastname: Gilain
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002675:Child, Preschool; D003287:Contrast Media; D004322:Drainage; D004487:Edema / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008199:Lymphadenitis / Q000382:microbiology / Q000628:therapy; D008297:Male; D015641:Radiography, Interventional; D017703:Retropharyngeal Abscess / Q000000981:diagnostic imaging* / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D013396:Suction; D014057:Tomography, X-Ray Computed
chemical_list: D000900:Anti-Bacterial Agents; D003287:Contrast Media
keywords: Child; Neck CT scan; Percutaneous aspiration; Retropharyngeal abscess; Streptococcus pyogenes