Contribution of CT scan and CT-guided aspiration in the management of retropharyngeal abscess in children based on a series of 18 cases

Abstract

Contrast-enhanced neck CT scan confirmed the diagnosis of retropharyngeal abscess and the indication for surgical drainage. It must be performed urgently, on admission. When it is decided to treat the patient with antibiotics alone, follow-up imaging should be performed in the absence of improvement 24 to 48 hours after starting antibiotics. CT-guided percutaneous aspiration is both a diagnostic modality confirming abscess formation of an inflammatory lesion of the retropharyngeal space as well as a therapeutic tool, sometimes avoiding the need for surgical drainage.

A rare case of tuberculous abscess causing airway obstruction in a paediatric patient in South-East Asia

“…Children with bacterial retropharyngeal abscess typically present with fever, neck pain, torticollis, neck stiffness, and presence of cervical lymphadenopathy [9] . Late presenting symptoms can include stridor, shortness of breath, dysphagia and sepsis.…”

“…Based on the findings of previous authors, who have reported on non tuberculous retropharyngeal abscesses in children, majority of cases responded to intravenous antibiotics exclusively. This can be effectively predicted radiologically as published in the Société française d'ORL guidelines, when the smallest diameter of the collection is less than 15mm [9] . Failure of response to medical treatment after 72 hours, or presence of airway compromise, would necessitate surgical drainage [9] .…”

Cone beam computed tomography-guided transpterygoidal aspiration of a carotid space abscess in Lemierre's syndrome

“…Abscesses infrequently complicate Lemierre's syndrome in children [1] , [2] . Suppurative deep neck space infections of all causes in children are generally uncommon, typically occurring in the retropharyngeal space and accompanying an upper respiratory tract infection [3] . The condition may become life-threatening due to sepsis or respiratory compromise, prompting a need for airway securement and surgical evacuation.…”

“…Conservative treatment with supportive measures and intravenous antibiotics may be considered for stable patients. Image-guided aspiration provides both diagnostic and therapeutic benefits, particularly when conservative methods have failed, and may avoid the need for surgery [3] .…”

Acute Infections that Produce Upper Airway Obstruction

“…Percutaneous CT-guided aspiration has also been described. 97 In one older series, 25% of patients required no surgery, 95 but in the Salt Lake City series that covered 1993-1998, 58% of 64 patients had antibiotics alone, with no treatment failures. 84 Data from KID 2003 (discussed earlier in the chapter) showed that 43% of cases admitted required surgical drainage.…”