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Kicking off a Retropharyngeal Abscess

A Rana1, L Heffernen1, J Binchy1

  • 1Department of Emergency Medicine, University Hospital Galway, Ireland

Irish Medical Journal
|May 25, 2019
PubMed
Summary

A retropharyngeal abscess (RPA) can be life-threatening. This case shows trauma can mask RPA symptoms, delaying diagnosis in a child with neck pain.

Area of Science:

  • Deep neck space infections
  • Pediatric emergency medicine
  • Diagnostic challenges in deep neck infections

Background:

  • Retropharyngeal abscesses (RPAs) are serious deep neck infections that can lead to airway compromise.
  • Prompt diagnosis and treatment are crucial for favorable outcomes.

Observation:

  • A 3-year-old girl presented with neck pain and limited range of motion after a sibling's kick.
  • Initial examination and cervical spine X-ray suggested a facet joint injury, delaying RPA diagnosis.
  • The patient lacked typical RPA symptoms, making the traumatic history a misleading factor.

Findings:

  • Magnetic Resonance Imaging (MRI) ultimately revealed a retropharyngeal abscess.
  • The abscess was successfully treated with incision, drainage, and antibiotics.

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  • This case underscores the atypical presentations of RPAs in pediatric patients.

    • Implications:

    • Physicians must consider retropharyngeal abscesses even when trauma is the presenting complaint.
    • Unusual presentations of deep neck infections require a high index of suspicion.
    • Trauma history can be a diagnostic red herring, necessitating comprehensive evaluation.