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Point of Care Ultrasound (POCUS) Diagnosis of Deep Neck Space Abscess: A Case Series
Eric Scheier1, Efrat Shapira-Levy2, Shachar Oren2
1Pediatric Emergency, Kaplan Medical Center, Rehovot, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Insights
Point-of-care ultrasound (POCUS) effectively diagnoses pediatric deep neck infections like para and retropharyngeal abscesses. This imaging method aids emergency physicians in timely diagnosis, preventing serious complications.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Ultrasound Applications
Background:
- Deep neck infections, including para and retropharyngeal abscesses, pose significant risks in children.
- Potential complications include airway obstruction, mediastinitis, and vascular issues.
- Conventional diagnosis via CT scans involves radiation exposure and may necessitate sedation.
Purpose of the Study:
- To evaluate the utility of point-of-care ultrasound (POCUS) in diagnosing pediatric para and retropharyngeal abscesses.
- To present a case series demonstrating POCUS effectiveness in a pediatric emergency setting.
- To highlight a novel imaging approach for deep neck spaces.
Main Methods:
- A case series of four children diagnosed with para or retropharyngeal abscesses using POCUS.
- POCUS findings were subsequently confirmed by CT scans.
- A new technique for identifying deep neck anatomical landmarks during ultrasound was employed.
Main Results:
- POCUS successfully diagnosed para or retropharyngeal abscesses in all four pediatric cases.
- Initial physical examinations by emergency physicians or otolaryngologists suggested alternative diagnoses.
- The novel imaging approach facilitated landmark identification.
Conclusions:
- POCUS is a valuable tool for diagnosing deep neck abscesses in children.
- Early and accurate diagnosis by emergency physicians using POCUS can prevent severe sequelae.
- POCUS offers a radiation-free alternative for evaluating deep neck spaces in pediatric patients.
Background:
Para and Retropharyngeal abscesses are deep neck infections of early childhood that can be complicated by serious sequelae such as airway obstruction, cervical necrotizing fasciitis, mediastinitis, aspiration pneumonia, jugular thrombosis or aneurysm of the carotid artery. Traditionally, these infections were diagnosed with computed tomography (CT) of the neck, which exposes sensitive structures to radiation and may require sedation.
Case Report:
We present a case series of four children diagnosed using point of care ultrasound (POCUS) with para or retropharyngeal abscess later confirmed on CT. All four had alternative working diagnoses on pediatric emergency physician or otolaryngology physical examination prior to investigation with POCUS. We also describe a novel imaging approach that allows for easier identification of deep neck anatomic landmarks. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?': Pediatric emergency physicians should be skilled in imaging the deep neck spaces in order to avoid delayed diagnosis of deep neck space abscess and its potentially catastrophic sequelae.
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