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A 15-Month-Old Boy With Respiratory Distress and Parapharyngeal Abscess: A Case Report
Behdad Gharib1, Masoud Mohammadpour1, Meisam Sharifzadeh1
1Department of Pediatric Intensive Care, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Insights
A parapharyngeal abscess in a child caused breathing difficulty and required emergency surgery. Delayed diagnosis led to complications like pneumothorax, highlighting the need for thorough clinical evaluation.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Critical Care
Background:
- Parapharyngeal abscesses are severe infections often stemming from upper respiratory infections in children.
- Prompt recognition and management are crucial due to potential airway compromise.
Observation:
- A 15-month-old boy presented with respiratory distress due to a parapharyngeal abscess.
- Initial orotracheal intubation was difficult, necessitating a tracheostomy.
- Respiratory status worsened post-operatively, revealing pneumothorax and subcutaneous emphysema.
Findings:
- The parapharyngeal abscess was not diagnosed on initial examination despite suggestive symptoms.
- Clinical indicators included respiratory distress, drooling, torticollis, neck swelling, and prior respiratory infection.
- Subsequent imaging confirmed a right-sided pneumothorax and cervical subcutaneous emphysema.
Implications:
- This case underscores the critical importance of meticulous physical examination and detailed history taking in pediatric emergencies.
- Early and accurate diagnosis of parapharyngeal abscesses can prevent life-threatening complications.
- Reinforces the need for heightened clinical suspicion in cases with subtle but significant signs.
Abstract:
Parapharyngeal abscess is a life-threatening disease. Upper respiratory tract infection is the main cause in children. We present a 15-month-old boy admitted to the emergency ward with the chief complaint of difficulty in breathing caused by parapharyngealabscess. His condition deteriorated gradually, and he transferred to the operation theater quickly for abscess drainage and because of the difficulty in orotracheal intubation; a tracheostomy was performed. His respiratory condition deteriorated 2 days after PICU admission, and the medical team noticed an unexplainable respiratory distress. A chest x ray obtained and showed a right side pneumothorax and subcutaneous emphysema around theneck area. The case presented here, had not been diagnosed at the first examination; however, there were enough clinical clues (such as respiratory distress, drooling, torticollis, bulging of theneck, previous viral respiratory infection, possible pharyngeal trauma). The story of this case reminds us the importance of the precise physical exam and history taking which could be life-saving.
