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Neck swelling from a retropharyngeal abscess caused by penicillin-resistant Streptococcus pneumoniae: a case report
Yukiyoshi Hyo1, Hisaki Fukushima, Tamotsu Harada
1Department of Otolaryngology, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama 701-0192, Japan. yuki-hyo@med.kawasaki-m.ac.jp.
Insights
A rare case of a retropharyngeal abscess and cystic lymphangioma co-occurring in a child highlights diagnostic challenges. Early intervention with drainage and antibiotics led to patient improvement.
Area of Science:
- Pediatric Otolaryngology
- Head and Neck Surgery
- Medical Imaging
Background:
- Retropharyngeal abscesses are common in children following upper respiratory infections.
- Diagnosis in young children is challenging and can lead to rapid progression to deep neck infections.
- Cystic lymphangiomas are benign vascular tumors typically presenting in children.
Observation:
- A 2-year-old boy presented with neck swelling, bilateral tonsillitis, and posterior pharyngeal wall swelling.
- CT angiography revealed a retropharyngeal abscess and suspected secondary deep neck infection.
- Surgical exploration diagnosed both a retropharyngeal abscess and cystic lymphangioma.
Findings:
- The patient's lesions improved with intraoral incision, drainage, and antibiotics.
- This is the first reported case of concomitant retropharyngeal abscess and cystic lymphangioma in the literature.
- Both conditions are more prevalent in children than adults.
Implications:
- Highlights the possibility of concurrent retropharyngeal abscess and cystic lymphangioma in pediatric neck masses.
- Emphasizes the need for thorough diagnostic evaluation in children with suspected deep neck infections.
- Suggests that early and appropriate management can lead to favorable outcomes.
Background:
In small children, retropharyngeal abscesses usually occur after upper respiratory tract infections. Unlike in adults, these abscesses are difficult to diagnose in small children, and can rapidly develop into deep neck or mediastinal abscesses.
Case Presentation:
A 2-year-old Japanese boy recently presented to our department with a chief complaint of neck swelling. Physical examination revealed bilateral tonsillitis and swelling of the left posterior pharyngeal wall. Emergency neck computed tomography angiography showed a contrast-enhanced abscess cavity posterior to the left retropharyngeal space, and a low-density area surrounded by an area without contrast enhancement in the posterior neck. The latter was suspected to be a deep neck infection secondary to a retropharyngeal abscess. After surgery, the patient was diagnosed with a retropharyngeal abscess and concurrent cystic lymphangioma. The lesions improved after intraoral incision and drainage, and administration of antibiotics.
Conclusion:
Lymphangiomas and retropharyngeal abscesses are both known to be more common in children than in adults. However, we found no other reports of concomitant presentation of lymphangioma and retropharyngeal abscess in the literature.
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