Tuberculous retropharyngeal abscess with cervical Pott disease and active pulmonary tuberculosis
Presentation
The patient complains of neck pain, dysphagia, odynophagia and body weight loss.
Patient Data
Topogram shows large retrophayrngeal soft tissue swelling which is significantly encroaching upon the orophayrngeal and hypophayrngeal air column. Bony erosions of the anterior aspect of C3 vertebra.
The contrast enhanced CT scan of the neck showed multiloculated retrophayrngeal abscess collections showing enhancing margins (seen in axial, sagittal and coronal images) spanning from the level of the orophayrnx to the upper mediastinum, extending to the prevertebral space.These lesions caused significant narrowing of the oropharyngeal and hypopharyngeal airways.
Sagittal bone window shows bony erosions of the anterior aspect of C3 and C5 vertebral bodies, impressive of cervical Potts disease.
Axial lung window shows left upper lobar large consolidation which shows internal air bronchogram and cavitations. Left lower lobar medial segment consolidations. Scattered small tree-in bud and nodular densities. Enlarged left hilar lymph nodes.
These findings were suggestive of retropharyngeal TB abscesses with cervical spine Pott's disease and active pulmonary TB..
Case Discussion
The case shows extensive and chronic retropharyngeal abscess, collections associated with adjacent cervical spine Pott's disease, and typical features of active pulmonary TB.
The patient tested positive for sputum acid-fast bacilli (AFP) and genexpert for TB and was planned for surgical drainage combined with antituberculous drugs.
Chronic retropharyngeal abscess is usually seen in adults and is often caused by tuberculosis (TB).
It is usually associated with a direct extension from adjacent cervical Pott disease 1 or might spread from tuberculous infection via lymphatics involving the retropharyngeal lymph nodes. It rarely spreads via haematogenous route 1.
As in our case, odynophagia and dysphagia are the principal symptoms of retropharyngeal abscess.
Early diagnosis and treatment are important to avoid complications such as neurological deficits and airway obstruction 1.
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