Two day history of increasing left sided neck/throat pain with associated otalgia and subjective fevers. Left sided throat swelling and tonsillar exudate. No stridor.
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An enlarged lymph node within the left-sided retropharyngeal space is of low density indicating suppuration. There is extensive oedema/inflammatory change present within the retropharyngeal space extending from the level of the clivus to the C7/T1 junction, consistent with retropharyngeal phlegmon without mature abscess formation. This produces mass effect on the adjacent pharynx. The airway remains patent. There is no epiglottic oedema. Enlarged lymph nodes throughout neck bilaterally. Visible lung fields are normal.
Suppurative lymphadenitis may seed locally within the retropharyngeal space leading to cellulitis/phlegmon. Phlegmon may proceed to abscess formation, characterised by a peripherally enhancing rim surrounding the hypodense collection on post contrast imaging.
Patients should be treated IV antibiotics covering upper respiratory organisms including anaerobes and ENT consultation should be obtained.
Case courtesy of Dr Stapleton.