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Shortness of breath. Neck swelling. Three days of odynophagia/dysphagia. No stridor.
Neck and Chest
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Hypodense collection within the retropharyngeal space, extending from the level of C1, with a maximal depth of 1.4cm at the level of C3. Extension into left prevertebral and paraspinal muscles where multiple loculated, rim-enhancing collections are demonstrated. A 8.3cm low density region is demonstrated at the posterior aspect of nasopharnyx on the left, also likely representing a collection. Anterior displacement of the esophagus. Airway is patent.
Within the chest, a moderate amount of fluid and stranding is demonstrated within the mediastinum. Non-enlarged mediastinal lymph nodes are noted. Small bilateral pleural effusions and bibasal atelecatsis.
Conclusion: Appearance is consistent with a retropharyngeal abscess with extension into the left perivertebral space and superior mediastinum.
Acknowledgement: Dr Sara Wein & A/Prof Rick Dowling.
The patient was admitted to ICU and underwent a subsequent surgical drainage of the retropharyngeal abscess and Streptococcus pyogenes (group A) was subsequently cultured.
This case demonstrates extension into the perivertebral space and superior mediastinum, which are known complications of retropharyngeal abscess.
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