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Retropharyngeal abscess
1Children's Hospital, Camperdown, Sydney, Australia.
Insights
Retropharyngeal abscesses are common in infants, often presenting with classic symptoms. Early diagnosis via lateral neck radiography is crucial for effective treatment and preventing recurrence in pediatric patients.
Area of Science:
- Pediatrics
- Otolaryngology
- Infectious Diseases
Background:
- Retropharyngeal abscesses are serious infections in children.
- Infants, particularly those under 12 months, are disproportionately affected.
- Predisposing factors include upper respiratory infections and pharyngeal trauma.
Purpose of the Study:
- To analyze the clinical presentation, diagnosis, microbiology, and outcomes of retropharyngeal abscesses in children.
- To identify age-related differences in clinical manifestations.
- To evaluate the diagnostic utility of lateral neck radiography.
Main Methods:
- Retrospective chart review of 31 pediatric patients treated for retropharyngeal abscess between 1954 and 1990.
- Analysis of patient demographics, clinical symptoms, diagnostic methods, microbial cultures, and treatment outcomes.
- Comparison of clinical presentation between children under and over 1 year of age.
Main Results:
- 55% of patients were 12 months or younger; 32% were under 6 months.
- Classical symptoms (fever, neck swelling, stridor) were more common in infants.
- Lateral neck radiography showed 88% sensitivity; Staphylococcus aureus and mixed Gram-negative/anaerobic organisms were common pathogens.
- Recurrence rate was 24%.
Conclusions:
- Retropharyngeal abscesses predominantly affect young children and infants.
- Clinical presentation varies with age, with infants exhibiting more pronounced symptoms.
- Prompt diagnosis and appropriate management are essential to reduce morbidity and recurrence.
Abstract:
Of 31 children with retropharyngeal abscess treated at this hospital between 1954 and 1990, 17 (55%) were 12 months old or less and 10 (32%) less than 6 months. Three of these 10 children were neonates, only one of whom had a predisposing congenital lesion. Fourteen children (45%) had a preceding upper respiratory illness and four (13%) had a prior history of pharyngeal trauma or ingestion of a foreign body. In children less than 1 year old the clinical presentation was usually classical with fever, neck swelling, stridor, and pharyngeal swelling. Significantly fewer children over 1 year had neck swelling and no child over 3 years old had stridor. A lateral radiograph of the neck, when performed, had a sensitivity of 88% in diagnosis. Bacteria isolated included pure growths of Staphylococcus aureus (25%), klebsiella species (13%), group A streptococcus (8%), and a mixture of Gram negative and anaerobic organisms (38%). There were two deaths. In six cases (24%) the abscess recurred necessitating further surgical drainage.