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Retropharyngeal abscesses in children: a 10-year review
1Department of Anesthesiology, Children's Hospital, Denver, CO 80218.
Insights
Retropharyngeal abscess in children is a rare but serious deep-neck infection that can obstruct the airway. This review highlights airway compromise and hypopharyngeal perforations as key complications in pediatric cases.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Emergency Medicine
Background:
- Retropharyngeal abscess (RPA) is a rare deep-neck infection in children.
- It can lead to serious airway compromise and may mimic other conditions.
- Early diagnosis and management are crucial.
Purpose of the Study:
- To review cases of retropharyngeal abscess in children.
- To identify common clinical presentations and complications.
- To evaluate diagnostic and management strategies.
Main Methods:
- Retrospective review of 17 pediatric cases of retropharyngeal abscess.
- Data collected from 1976 to 1986 at The Children's Hospital, Denver.
- Analysis of clinical presentation, diagnostic findings, and treatment outcomes.
Main Results:
- Nine children (56%) experienced stridor or airway obstruction.
- Seven patients (41%) had hypopharyngeal or esophageal perforations.
- Lateral neck X-rays confirmed RPA in all cases, often showing air/fluid levels.
Conclusions:
- Retropharyngeal abscess in children frequently presents with airway compromise and a high incidence of perforations.
- Prompt surgical intervention and airway management are essential.
- Diagnostic imaging, particularly lateral neck X-rays, is vital for confirmation.
Abstract:
Retropharyngeal abscess is a rather rare, deep-neck infection of children and may seriously compromise the airway and mimic other diseases. A retrospective review of 17 cases of retropharyngeal abscess presenting to The Children's Hospital, Denver, from 1976 to 1986 was performed. Nine children (56%) had stridor or airway obstruction. Seven patients (41%) had perforations of their hypopharynx or esophagus, including two neonates (most likely associated with intubation attempts). Two patients presented in the emergency department with a tentative diagnosis of "epiglottitis," while another referred to as having "persistent fever" was found to have a needle embedded in the hypopharynx. Fourteen children (81%) were brought to the operating room for examination and/or drainage of the abscess under general anesthesia. One child received an elective tracheotomy, and two others remained intubated postoperatively, pending resolution of their airway compromise. X-rays of the lateral neck were confirmatory in all these cases, with an unusually high incidence of "air/fluid levels," probably reflecting the corresponding large number of perforations of the hypopharynx or esophagus with subsequent communication into the retropharyngeal space.