Retropharyngeal abscess presenting as acute airway obstruction in a 66-year-old woman: A case report

Abstract

BACKGROUNDAdult retropharyngeal abscess (RPA) is extremely rare, and most cases reported in the literature were related to tuberculous infection. We present a case of RPA with acute airway obstruction as the main manifestation in a 66-year-old woman that was considered to be non-tubercular suppurative inflammation in the retropharyngeal space.CASE SUMMARYA 66-year-old woman complaining of chills and fever was admitted to our hospital. She was initially diagnosed with an acute upper respiratory tract infection. She lost consciousness twice during hospitalization. She regained consciousness immediately upon emergency tracheal intubation. Acute upper airway obstruction was suspected as arterial blood gas analysis showed obvious acute retention of carbon dioxide before the second tracheal intubation. The diagnosis of RPA was confirmed by computed tomography and magnetic resonance imaging. Kocuria kristinae was isolated from blood samples taken from both hands. The patient recovered and was subsequently discharged after receiving antibiotic therapy together with surgical incision and drainage of the abscess.CONCLUSIONClinicians should be alert to the possibility of RPA in patients with acute airway obstruction. Surgical incision and drainage is an effective treatment for RPA.

A dangerous cause of airway obstruction: deep neck infection

“…Early diagnosis is critical to prevent acute airway obstruction at emergency department. However, maintenance of an adequate airway remains challenging and depends on the mechanism leading to airway obstruction from DNI (Table 1) [7,11,15,25]. The clinical presentation of DNI varies and depends on its infectious origin-for example, local pain from the infection of the mandibular teeth, tonsils, parotid gland, deep lymph nodes, middle ear, and sinuses [30][31][32].…”

“…A mass may be not readily visible or palpable externally, because the dense structure of the cervical fascia may hide the mass, or the location of the DNI is hidden by the neighboring organs, such as the trachea, esophagus, and vertebrae [16,39,40]. Palpation of the oral cavity, leukocytosis, C-reactive protein levels, arterial blood gas analysis, direct laryngoscopy, neck computed tomography, and neck magnetic resonance imaging are recommended in identifying the mass [24][25][26][39][40][41]. To find the collection of deep pus due to DNI, a pitting appearance, focal tenderness, or a doughy feeling are the characteristic signs by firm deep palpation.…”

“…Besides, pain or fluid collection affecting the muscles of mastication (the masseter and pterygoid) or impairing the motor branch of the trigeminal nerve can limit maximal mouth opening can lead to trismus [42]. Presence of laryngeal edema, laryngeal spasm, loss of consciousness, or stridor is indicative of airway crisis and a difficulty in trachea intubation that requires tracheostomy [20,25,43].…”

“…It communicates laterally with the parapharyngeal space. The complications of retropharyngeal space infection include hemorrhage, airway compression, asphyxiation resulting from spontaneous abscess rupture into the airway, and laryngeal spasm; these complications can be life threatening because of the risk of acute respiratory failure [24,25].…”

Tubercular Retropharyngeal Abscess With Pott’s Disease in an Elderly Male Patient

“…RPA is a rare but well-recognized form of extra-pulmonary tuberculosis in the developing world [9][10][11]. It should be suspected in adults presenting with dysphagia and acute respiratory compromise [12]. The primary goal of the treating physician is to secure the airway at the earliest and then consider surgical drainage of RPA, followed by definitive anti-tubercular therapy.…”