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Correlation between computed tomography and surgical findings in retropharyngeal inflammatory processes in children
M E Stone1, D L Walner, B L Koch
1Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
Insights
Computed tomography (CT) accurately distinguishes retropharyngeal abscess (RPA) from cellulitis in children in 73.5% of cases. Clinical and radiologic findings are crucial for surgical decisions in suspected RPA.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Infectious Diseases
Background:
- Retropharyngeal abscess (RPA) in children is a serious condition often requiring urgent surgery.
- Contrast-enhanced computed tomography (CT) is a key tool for differentiating RPA from cellulitis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of CT in distinguishing RPA from cellulitis in pediatric patients.
Main Methods:
- Retrospective review of 32 children with suspected RPA from 1989-1997.
- Comparison of CT findings with surgical exploration results within 48 hours.
Main Results:
- CT correctly identified abscess or cellulitis in 73.5% (25/34) of cases.
- False positive rate was 11.8% (4/34); false negative rate was 14.7% (5/34).
Conclusions:
- CT demonstrates good accuracy in differentiating pediatric RPA from cellulitis.
- Integrating clinical and radiologic findings is essential for guiding surgical intervention.
Abstract:
Retropharyngeal abscess (RPA) in children is a potentially life-threatening process which often requires immediate surgical intervention. Contrast enhanced computed tomography (CT) is utilized frequently to determine abscess versus cellulitis/phlegmon and aids in determining cases needing surgical drainage. The purpose of this retrospective study was to determine the accuracy of CT in distinguishing retropharyngeal abscess from cellulitis in children. The medical records of 32 children from 1989 to 1997 suspected of having a retropharyngeal abscess were reviewed. All patients included in the study underwent a CT scan as well as surgical exploration within 48 h of the scan. Two patients required two surgical procedures (n = 34). A comparison between CT results and operative findings was made to determine the accuracy of CT imaging in confirming the presence of RPA versus cellulitis. Suspected diagnosis of abscess or cellulitis/phlegmon on CT was confirmed at surgery in 25 of 34 cases (73.5%). The false positive rate of CT scan was 11.8% (4/34), while the false negative rate was 14.7% (5/34). Based on our results, CT is accurate in differentiating abscess from cellulitis in 73.5% of cases. Clinical findings, as well as radiologic findings, must be considered together prior to surgical drainage of a suspected retropharyngeal abscess in children.