Supraglottic airway infections

Varicella Infection Complicated by Group A Beta-Hemolytic Streptococcal Retropharyngeal Abscess

An unimmunized 19-month-old child presented with a retropharyngeal abscess and coincident varicella infection. The abscess resolved with operative drainage. This is the first published report of this connection, although varicella is known to be associated with abscesses in general. Practitioners should be aware that cervical abscesses may complicate varicella infections.

Neck swelling from a retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae: a case report

Background

In small children, retropharyngeal abscesses usually occur after upper respiratory tract infections. Unlike in adults, these abscesses are difficult to diagnose in small children, and can rapidly develop into deep neck or mediastinal abscesses.

Case presentation

A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling. Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall. Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck. The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess. After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma. The lesions improved after intraoral incision and drainage, and administration of antibiotics.

Conclusion

Lymphangiomas and retropharyngeal abscesses are both known to be more common in children than in adults. However, we found no other reports of concomitant presentation of lymphangioma and retropharyngeal abscess in the literature.

Multiple abscesses with osteomyelitis and destruction of both the atlas and the axis in a 4-week-old infant

STUDY DESIGN

Case report.

OBJECTIVE

To report an unusual case of a 4-week-old infant with multiple abscesses, which propagated to the cervical region and destroyed the C1-C2 vertebrae.

SUMMARY OF BACKGROUND DATA

Cervical vertebral osteomyelitis involving the atlas and axis in childhood is distinctly unusual, which may lead to the rapid destruction of the vertebral body. Propagation of a retropharyngeal abscess is the major cause of cervical vertebral osteomyelitis. Only a limited number of infant case reports are published, and no case of osteomyelitis with the destruction of both the atlas and the dens axis has been reported previously.

METHODS

A 1-month-old infant with multiple craniospinal and thoracic abscesses was surgically treated. Therapy was completed with antibiotics and immobilization. Follow-up was carried out with magnetic resonance imaging, computed tomographic scans, and functional radiographical diagnostics.

RESULTS

The retropharyngeal and thoracic abscesses were surgically removed. The infant was placed in a custom-made fixation device for 8 weeks. Two months later, follow-up functional examination revealed no significant instability of the cervical spine. During a 3-year-long follow-up period, no signs of neurological impairment were observed, neck movements were limited but painless. It is assumed that the remnants of the bony elements of C1-C2 vertebrae and the massive interconnecting postinflammatory scar tissue make some degree of neck movements possible.

CONCLUSION

C1-C2 osteomyelitis is a very rare entity even in children. There is limited experience with treatment, but immobilization of the neck, surgical debridement, drainage, and antibiotic treatment can be recommended. Close follow-up is required to check the reconstitution of affected bones and ligaments, any development of instability, and the necessity of surgical stabilization.

Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management

OBJECTIVE

We sought to describe the clinical presentation of patients with retropharyngeal abscess (RPA), utility of imaging studies, and implications on management.

METHODS

A retrospective chart review was performed at a tertiary-care, pediatric hospital with cases identified by a discharge diagnosis of RPA; posttraumatic RPA cases were excluded. Patients without confirmatory radiographic findings, fluoroscopy, or computed tomography (CT) were excluded.

RESULTS

Sixty-four cases involving 64 patients were studied. The median age of the patients was 36 months; 48 (75%) of the 64 patients were younger than 5 years. The most common chief complaints were neck pain (38%), fever (17%), sore throat (17%), neck mass (16%), and respiratory distress or stridor (5%). In 29 children (45%), it was noted that there was limitation of neck extension, in 23 (36.5%) torticollis, and in 8 (12.5%) limitation of neck flexion. The physical examination revealed stridor with wheezing in only 1 patient (1.5%) and wheezing in 1 other (1.5%). Twenty-seven patients (42%) underwent surgery; 37 (58%) were treated with antibiotics only. Performance of a surgical procedure was significantly associated with CT scan findings. Ten (37%) of 27 patients with defined abscess on CT scan were treated with antibiotics alone. There were no treatment failures in either the antibiotic-only group or the antibiotics-plus-surgery group.

CONCLUSIONS

Children with RPA present with limitation of neck movement, especially difficulty extending their neck to look up. They rarely present with respiratory distress or stridor. CT scan is useful to distinguish patients with RPA from those with retropharyngeal cellulitis. Most patients with retropharyngeal cellulitis and some with RPA can be treated successfully without surgery.

Group B streptococcal retropharyngeal cellulitis in a young infant: a case report and review of the literature

The diagnosis of retropharyngeal cellulitis and abscess, although most common in children under 6 years of age, is often misdiagnosed in the newborn or early infancy period. The clinical signs of drooling, neck swelling, dysphagia, and torticollis may be absent or not easily identifiable. The following case report details a 2 1/2-month-old infant who presented with fever and irritability, and was subsequently diagnosed with group B streptococcal retropharyngeal cellulitis. Retropharyngeal cellulitis and abscess should be considered in the differential diagnosis of infants and young children who present with fever and irritability, particularly when lumbar puncture results are normal. This case also serves to highlight a rare manifestation of late-onset group B steptococcal disease.