儿童咽后壁脓肿误诊2例并文献复习

MISDIAGNOSIS OF RETROPHARYNGEAL ABSCESS IN 2 CHILDREN AND LITERATURE REVIEW

目的:探讨儿童咽后壁脓肿的致病因素、临床特点、诊断及治疗原则。方法:报告我院近期接诊的2例咽后壁脓肿患儿,分析其误诊误治的情况,并结合相关文献进行总结。结果:病例1患儿反复发热、颈部包块,被误诊为“颈部淋巴结炎”,经治疗后颈部包块有好转,后包块再次增大,颈部彩超提示颈部巨大囊性包块,及时予切开排脓,证实为咽后壁脓肿,经治疗好转。病例2患儿发热,伴咳嗽,咽痛、异物感明显,伴声嘶、喉鸣,双面颊肿痛,渐蔓延至颈部,伴活动受限、气促、不能言语,被误诊为“急性喉气管支气管炎、化脓性腮腺炎?”,及时完善颈部CT提示咽后壁脓肿,及时予切开排脓,并予以抗感染治疗好转。结论:咽后壁脓肿多见于婴幼儿,感染是最常见的病因,临床症状常较重,可表现为发热、咽痛、吞咽困难、言语不清、颈部后仰、声嘶、呼吸困难等,易误诊为喉炎、颈部淋巴结炎等。在掌握患儿病史信息的基础上,及时完善对诊断有重要价值的影像学检查,确诊后及时行手术切开引流并抗感染治疗。

Objective:To explore the pathogenic factors,clinical features,diagnosis and treatment principles of retropharyngeal abscess in children.Methods:The misdiagnosis and mistreatment of 2 children with retropharyngeal abscess admitted in our hospital recently were analyzed and summarized combing relevant literature.Results:Case 1 was misdiagnosed as"cervical lymphadenitis"because of repeated fever and cervical mass.The cervical mass improved after treatment but enlarged again.The color Doppler ultrasound of neck showed huge cystic mass in neck,which was proved retropharyngeal abscess after treatment.Case 2 suffered with fever,cough,sore throat,foreign body sensation,hoarseness,sore throat,bilateral cheek swelling and pain,gradually spread to the neck,with limited movement,shortness of breath,unable to speak,and was misdiagnosed as"acute laryngotracheobronchitis,purulent mumps?".The neck CT showed retropharyngeal abscess,and the children improve after timelyi ncision and drainage of pus,as well as anti-infection treatmnet.Conclusions:Retropharyngeal abscess is common in children,infection is the most common cause.The clinical symptoms are often severe,which include fever,sore throat,dysphagia,unclear speech,neck backward,hoarseness,dyspnea,etc.The imaging examination that has important value for diagnosis should be improved timely on the basis of mastering the medical history information of children.The children should be treated with surgical drainage and anti-infection after diagnosis timely.