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[Retropharyngeal abscess in nursing infants. Report of 2 cases]
M Berzioli1, P Brisotto, R Bozzo
1Divisione Pediatrica, Ospedale di Montebelluna (TV), Italia.
Insights
Retropharyngeal abscess is a rare but severe condition in breast-fed infants, presenting with difficulty swallowing and breathing. Early diagnosis via neck X-ray and prompt antibiotic or surgical treatment are crucial to prevent serious complications.
Area of Science:
- Pediatric Otolaryngology
- Infectious Diseases
- Radiology
Background:
- Retropharyngeal abscesses are uncommon but serious infections in infants.
- This condition can present atypically in breast-fed babies.
Observation:
- Two cases of retropharyngeal abscess in breast-fed infants are presented.
- Key clinical signs include age (breast-fed infants), dysphagia, drooling, dyspnea, and malaise.
Findings:
- Diagnosis is aided by pharyngeal/palatal movement assessment and lateral neck radiography revealing retropharyngeal space widening.
- Common etiological agents include Streptococcus anginosus group (S.B.E.A.), anaerobes, Staphylococcus, and Gram-negative bacteria.
Implications:
- Untreated abscesses can lead to severe complications like bronchopulmonary spread, obstructive apnea, mediastinitis, and fistulas.
- Treatment involves appropriate antibiotics and, in suppurative stages, surgical drainage.
Abstract:
The authors report two cases of retropharyngeal abscess in breast-fed babies and highlight the salient points of the disease: 1) The disease is rare, severe and sometime atypical. 2) The clinical features are: the patient age (breast-fed babies), difficult in swallowing, drooling, dyspnea and malaise. 3) The diagnosis is confirmed by a forward movement of the pharynx and of the soft palate except when the abscess is located on the lower half of the retropharyngeal space. 4) The most important diagnostic procedure is the lateral radiography of the neck that shows a widening of the retropharyngeal prevertebral space. 5) If an adequate therapy is not undertaken, following complications are possible: opening of the abscess with passage of the pus into the bronchopulmonary space, obstructive dyspnea with oxygen lack, propagation of the abscess into the mediastinum and possible development of fistulas into lung, and pleura, and exceptionally into pericardium. 6) The therapy includes the use of drugs active toward the possible etiological agents: the most common are the S.B.E.A., anaerobes, staphylococcus and gram-negative. At stage of suppuration, surgical operation is required.