Paediatric Radiology


Case  17 :  
Pediatric Radiology
A young boy presents with fever and sore throat of 15 days duration.
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Diagnosis

Parapharyngeal abscess

Discussion

It is often difficult to determine clinically if a patient with an erythematous, painful and swollen neck has a simple cellulitis or a potentially life threatening deep neck abscess.

Abscesses appear as single or multi-loculated low density masses that conform to fascial planes, and demonstrate rim enhancement on CECT. Cutaneous and subcutaneous manifestations of abscesses include enlargement of adjacent muscles (myositis), thickening of overlying skin, and enhancement of fascial planes.

Cervical abscesses need to be mapped out to ensure proper surgical drainage. Abscesses are usually located within a single compartment or space within the neck. Infections that track along the superficial cervical fascia are often secondary to skin infections and rarely track deeper into the neck. Infections in the retropharyngeal space can extend into the retrocvisceral space upto level of T3 (where the alar layer and visceral layer fuse) or in the danger space inferiorly to the level of the diaphragm.

Infections of the retropharyngeal space in children are usually secondary to the medial retropharyngeal nodes. In adults it is usually due to perforation of the posterior wall of the pharynx or esophagus.

Dr. Ashok Raghavan, Manipal Hospital, Bangalore