Retropharyngeal abscess with mediastinal extension
Fever and chest pain.
CT neck and upper chest
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Air tracking in the neck along the left retropharyngeal space and left anterior cervical spaces which continues with the superior and posterior mediastinum to the infra-carinal region (T6) wrapping around the trachea and esophagus forming dependent air-fluid levels and showing marginal enhancement.
This case demonstrates retropharyngeal abscess with inferior extension into the mediastinum resulting in mediastinitis with abscess formation. Extension to the mediastinum is believed to be through the Danger space. When encountering the possibility of a retropharyngeal abscess, it is important to search for a pharyngeal foreign body (like impacted fish bone).
Mediastinitis is considered a surgical emergency with a high mortality rate. It can be primarily from structures in the mediastinum (often as a result of iatrogenic injury) or may result from an infection extending downward from the oropharynx, in which case it is called descending necrotizing mediastinitis (DNM).