Large retropharyngeal abscess: a case of mistaken identity

Abstract

We report an unusual case of nasopharyngeal carcinoma (NPC), presenting initially as a retropharyngeal collection. We discuss the investigation, diagnosis and management of NPC and furthermore review the literature of NPC, emphasising the varied presentation. A 44-year-old Caucasian male ex-smoker presented with a 10-day history of a painless left-sided neck lump; progressive dysphagia and unintentional weight loss. Examination demonstrated a large left posterior pharyngeal swelling with soft palatal effacement, confirmed on nasoendoscopy. A CT scan revealed a fluid collection in the retropharyngeal space, which partially occluded the nasopharynx, and numerous satellite lesions were identified along with cervical lymphadenopathy. The suspected abscess was drained in theatre and nasopharyngeal biopsies were taken. These revealed Epstein-Barr virus-positive NPC. Staging investigations revealed a T4N2M0l carcinoma. Treatment consisted of radical chemoradiation therapy with curative intent. NPC is known for its varied and late presentation, and is an important condition to be aware of when considering a differential diagnosis of pharyngeal masses.

Low-Dose Aspirin Use Significantly Improves the Survival of Late-Stage NPC: A Propensity Score-Matched Cohort Study in Taiwan

“…Unlike other head and neck cancers, NPC is characterized by increased invasiveness and metastasis [ 1 , 2 , 3 , 4 ]. Clinical presentation of NPC is highly varied and often results in delayed or missed diagnosis due to its anatomical position [ 5 , 6 ]. NPC is largely undetected and diagnosis is delayed until the tumor reaches an advanced stage, at which time distal-organ metastasis is common.…”