Retropharyngeal abscess: Difference between revisions
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*Late symptoms: | *Late symptoms: | ||
**Stridor, respiratory distres, chest pain (mediastinitis) | **Stridor, respiratory distres, chest pain (mediastinitis) | ||
==Differential Diagnosis== | |||
{{Sore throat DDX}} | |||
==Diagnosis== | ==Diagnosis== | ||
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** If equivocal XR, order CT | ** If equivocal XR, order CT | ||
== | ==Management== | ||
*Emergent ENT consult | *Emergent ENT consult | ||
**Most patients require I&D | **Most patients require I&D | ||
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==See Also== | ==See Also== | ||
*[[PTA]] | |||
*[[Ludwig's Angina]] | |||
*[[Pharyngitis]] | |||
== | ==References== | ||
<References/> | |||
[[Category: | [[Category:ENT]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Revision as of 10:21, 17 August 2015
Background
- Polymicrobial abscess in space between posterior pharyngeal wall and prevertebral fascia
- Adults: Due to direct extension of purulent debris from adjacent site (e.g. Ludwig angina)
- More likely to extend into the mediastinum
- Children: Due to suppurative changes within a lymph node (primary infection elsewhere in head or neck)
- Trauma: Direct inoculation (e.g. child falling with stick in mouth)
Clinical Features
- Sore throat (76%)
- Fever (65%)
- Torticollis (37%)
- Dysphagia (35%)
- Late symptoms:
- Stridor, respiratory distres, chest pain (mediastinitis)
Differential Diagnosis
Acute Sore Throat
Bacterial infections
- Streptococcal pharyngitis (Strep Throat)
- Neisseria gonorrhoeae
- Diphtheria (C. diptheriae)
- Bacterial Tracheitis
Viral infections
- Infectious mononucleosis (EBV)
- Patients with peritonsillar abscess have a 20% incidence of mononucleosis [1]
- Laryngitis
- Acute Bronchitis
- Rhinovirus
- Coronavirus
- Adenovirus
- Herpesvirus
- Influenza virus
- Coxsackie virus
- HIV (Acute Retroviral Syndrome)
Noninfectious
Other
- Deep neck space infection
- Peritonsillar Abscess (PTA)
- Epiglottitis
- Kawasaki disease
- Penetrating injury
- Caustic ingestion
- Lemierre's syndrome
- Peritonsillar cellulitis
- Lymphoma
- Internal carotid artery aneurysm
- Oral Thrush
- Parotitis
- Post-tonsillectomy hemorrhage
- Vincent's angina
- Acute necrotizing ulcerative gingivitis
Diagnosis
- CT neck w/ IV contrast
- Gold standard
- XR Soft tissue
- The prevertebral space should be less than 7mm at C2, 14mm at C6 in children regardless of the age
- The prevertebral space should be less than 22mm at C6 in adults
- If the prevertebral space should be less than one-half the width of the corresponding vertebral body
- If equivocal XR, order CT
Management
- Emergent ENT consult
- Most patients require I&D
- Secure airway
Antibiotics
- Clindamycin 600-900mg IV OR
- cefoxitin 2gm IV OR
- Ampicillin/Sulbactam 3g IV
Disposition
- Admit
See Also
References
- ↑ Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.