[Rational diagnosis of pediatric pharyngeal abscess]

Diagnostic procedures intend to differentiate superficial cervical abscesses from deep abscesses and uncomplicated lymphadenitis. They should provide identification of the causing agent, of the route of infection and of possible underlying diseases. Present techniques for examining pediatric cervical abscesses should be assessed.

Currently published data on diagnostic procedures in pediatric neck abscess from National Library of Medicine data files were evaluated. Moreover, clinical findings, diagnostic procedures, therapy and outcome of 47 children with cervical abscess treated from 1992-1996 were retrospectively evaluated.

Studies providing appropriate evidence on the value of various diagnostic procedures in pediatric cervical abscesses were not found. In 47 patients with confirmed cervical abscess treated at our department, clinical examination, erythrocyte sedimentation rate and ultrasound examination of the neck were sufficient to establish the correct diagnosis. Additional investigations such as MRI or CT-scans, chest X-rays, Mendel-Mantoux test, various virus titres and other laboratory examinations were performed only in selected cases. The route of invasion (tonsil, dental or otogeneous) could be identified in 13 children. In 4 children an infected cervical cyst was found.

Clinical examination, erythrocyte sedimentation rate and sonography are appropriate to establish the diagnosis of pediatric cervical abscess and in accordance with the principles of Managed Care.