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Retropharyngeal Abscess Complicated by Mediastinitis in Infants
Ann Thomas1, Shaun Adam2, Pierre Goussard3
1Department of Otorhinolaryngology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Insights
Paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis are rare but serious deep neck infections. Prompt diagnosis with CT scans and surgical intervention are crucial for successful management in young children.
Area of Science:
- Pediatric Infectious Diseases
- Otolaryngology
- Thoracic Surgery
Background:
- Upper respiratory infections in children are common and usually viral, leading to reactive lymphadenopathy.
- Retropharyngeal lymph nodes in children under 5 can develop deep neck space infections, including retropharyngeal abscesses (RPA).
- RPA is less common in children over 5 due to lymph node atrophy.
Purpose of the Study:
- To present a series of pediatric retropharyngeal abscesses (RPA) complicated by mediastinitis.
- To highlight the diagnostic and management challenges of these rare but severe infections in infants and young children.
Main Methods:
- Retrospective case series of 6 pediatric patients with RPA and mediastinitis over 4 years.
- Diagnosis confirmed by computed tomography (CT) scans, identifying RPA and mediastinal extension.
- All patients underwent surgical drainage for source control.
Main Results:
- All 6 cases presented with fever, difficulty feeding, and neck swelling.
- The age range was 11 weeks to 11 months; all were HIV-negative.
- Methicillin-sensitive Staphylococcus aureus (MSSA) was the causative agent in all cases. CT scans confirmed RPA with mediastinal extension.
- Surgical management led to successful extubation for all patients, with a maximum intubation duration of 3 days.
Conclusions:
- Management of pediatric RPA with mediastinitis requires close monitoring and airway management.
- CT or MRI is essential for assessing the extent of infection.
- Surgical drainage is indicated for large abscesses, complications, or failure to respond to medical management within 24-48 hours.
Introduction:
Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy.
Methods:
We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period.
Results:
All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks-11 months, and all tested negative for human immunodeficiency virus. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery, and the other 4 were extubated in the paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases.
Conclusion:
Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24-48 h to medical management.
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