0071643192.pdf

HEAD, EYE, EAR, NOSE, AND THROAT

EMERGENCIES

■ Consider admission with IV antibiotics and ENT consult.

■ Consider steroids and NSAIDs for inflammation.

COMPLICATIONS

■ Lemierre syndrome: Throat infection leading to septicemia caused by

Fusobacteriumsp.

■ Mediastinitis, intracranial extension, retropharyngeal abscess formation

■ Airway compromise

Retropharyngeal Abscess

ETIOLOGY

■ Mixed flora affecting the retropharyngeal space

■ Commonly after trauma (popsicle stick) or upper respiratory infection

■ Most common in children 3–5 years old

SYMPTOMS/EXAM

■ Fever, neck pain, sore throat

■ Dysphagia, trismus, stridor

■ Nuchal rigidity

■ Muffled voice “cri du canard” = duck-like voice

■ Lymphadenopathy

■ Intraoral exam shows anterior displacement of the posterior pharyngeal

wall due to swelling or mass.

DIAGNOSIS

■ Lateral soft tissue neck X-ray indicates retropharyngeal space at C2 is twice

the size of the vertebral body. Patient should hold head in sniffing position—

slight neck extension—to prevent false positive X-ray (see Figure 14.21).

■ CT is appropriate in patients with high probability of illness and to define

location of abscess.

FIGURE 14.21. Lateral neck view of a child with retropharyngeal abscess and

widened retropharyngeal space.

(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski SJ. Emergency

Medicine: A Comprehensive Study Guide, 6th ed.New York: McGraw-Hill, 2004:857.)

Be able to identify

retropharyngeal abscess

(wide retropharyngeal space),

croup (steeple sign), and

epiglottitis (thumb print sign)

on X-rays of the soft tissues of

the neck.