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Retropharyngeal infections in children. Treatment strategies and outcomes
C Hoffmann1, S Pierrot, P Contencin
1Pediatric ENT Department, Hôpital Necker - Enfants Malades, AP-HP, University of Paris V, France.
Insights
Optimizing retropharyngeal infection treatment in children is key. CT scans aid in choosing between medical and surgical approaches, with severe complications being rare.
Area of Science:
- Pediatric infectious diseases
- Otolaryngology
- Medical imaging
Background:
- Retropharyngeal infections in children require careful management.
- Optimizing treatment strategies can reduce complications and improve outcomes.
Purpose of the Study:
- To optimize the treatment of pediatric retropharyngeal infections.
- To evaluate the utility of CT scans in guiding treatment decisions.
Main Methods:
- Retrospective chart review of 101 pediatric cases.
- Analysis of medical and surgical treatment outcomes.
- Correlation of CT scan findings with treatment failure.
Main Results:
- Two-thirds of patients were male, with a mean age of 52 months.
- Medical treatment failure occurred in 18% of cases, surgical failure in 16%.
- CT scan characteristics (hypodense core, rim enhancement, size) correlated with treatment failure.
Conclusions:
- Severe complications from pediatric retropharyngeal infections are infrequent.
- CT scan is a valuable tool for selecting appropriate medical or surgical treatment.
- Treatment failures were associated with prolonged fever and hospital stay.
Objective:
To optimize the treatment of retropharyngeal infections in children.
Methods:
Retrospective chart review of 101 consecutive pediatric cases of retropharyngeal infections referred to our center from January 2006 to July 2009.
Results:
Two-thirds of patients were males. Their mean age was 52 months (range: 6-163). Upper airway obstruction was observed in three patients. In another child, the infection evolved towards a diffuse cervical cellulitis. Medical treatment was initially planned in 44% of patients. Failures requiring surgical drainage occurred in 18% of them. In 56% of cases, surgical treatment was immediately instigated. It failed in 16% of patients, requiring a second surgical drainage. There was no difference in the duration of fever and of hospital stay between patients initially treated medically or surgically. Both medical and surgical treatment failures were associated with longer durations of fever (p=0.002, and p<0.0001, respectively) and of hospital stay (p=0.0006, and p=0.0005, respectively). Some characteristics of CT-scan anomalies were correlated with treatment failure. A hypodense core surrounded by rim enhancement, with a largest long axis ≥ 20 mm, was more frequent in case of medical failure (p=0.02). Surgical failure was associated with the same feature, but with a largest long axis ≥ 30 mm (p=0.05).
Conclusions:
The present study suggests that severe complications are rare in pediatric retropharyngeal adenitis, and that CT-scan is a useful tool to choose between medical and surgical treatment.
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