Tuberculous retropharyngeal abscess without cervical spine TB

Tuberculous retropharyngeal abscess is a rare presentation.It is present in adults usually due to involvement of cervical spine by tuberculosis.Retropharyngeal space usually gets involved in children due to pyogenic organisms or secondary to trauma.Here is a case of tuberculous retropharyngeal abscess in an adult female,with pulmonary tuberculosis.The patient was not having tuberculous involvement of cervical spine and was managed surgically by aspirating the retropharyngeal abscess transorally and AKT Category I.

Retropharyngeal abscess presenting as acute airway obstruction in a 66-year-old woman: A case report

BACKGROUND Adult retropharyngeal abscess(RPA)is extremely rare,and most cases reported in the literature were related to tuberculous infection.We present a case of RPA with acute airway obstruction as the main manifestation in a 66-year-old woman that was considered to be non-tubercular suppurative inflammation in the retropharyngeal space.CASE SUMMARY A 66-year-old woman complaining of chills and fever was admitted to our hospital.She was initially diagnosed with an acute upper respiratory tract infection.She lost consciousness twice during hospitalization.She regained consciousness immediately upon emergency tracheal intubation.Acute upper airway obstruction was suspected as arterial blood gas analysis showed obvious acute retention of carbon dioxide before the second tracheal intubation.The diagnosis of RPA was confirmed by computed tomography and magnetic resonance imaging.Kocuria kristinae was isolated from blood samples taken from both hands.The patient recovered and was subsequently discharged after receiving antibiotic therapy together with surgical incision and drainage of the abscess.CONCLUSION Clinicians should be alert to the possibility of RPA in patients with acute airway obstruction.Surgical incision and drainage is an effective treatment for RPA.

Magnetic Resonance Imaging of Retropharyngeal Lymphadenopathy in Nasopharyngeal Carcinoma

OBJECTIVE The aim of our study was to document the patterns of RLN spread by using MRI. METHODS The MR images of 294 patients with newly diagnosed NPC were reviewed retrospectively. Criteria for metastatic lymph nodes included： shortest axial diameter, nodal necrosis, extracapsular spread, and a contrast enhancing rim. RESULTS RLN involvement was detected in 190 （64.6%） patients. A significantly higher incidence of metastatic RLNs was observed in patients with involvement of the oropharynx, nasal cavity, pre-styloid parapharyngeal space, post-styloid parapharyngeal space, levator muscle of the velum palatini, and tensor muscle of the velum palatine. Patients with level Ⅱ,Ⅲ, and Ⅴ node involvement also had a higher incidence of metastatic RLNs. Of the 231 patients who had metastatic RLNs or cervical lymph nodes, 43 （18.6%） had only metastatic RLNs, 41 （17.7%） had only metastatic cervical lymph nodes, and 147 （63.6%） exhibited an involvement of both the RLNs and cervical lymph nodes. The difference between the incidence of RLN involvements （82.3%） and the incidence of cervical lymph node involvement （81.4%） was very small. CONCLUSION Metastatic RLNs are significantly associated with early stage primary tumor involvement and supper cervical lymph node metastasis in NPC.

Giant Retropharyngeal Abscess in a Nigerian Adult Following Fish Bone Throat Injury

Retropharyngeal abscess (RPA) is an uncommon disease entity that typically occurs in children under 5 years of age, which has the potential to cause upper airway obstruction. Upper respiratory tract infection is the most common predisposing factor to RPA in children while cervical spine tuberculosis and trauma are the major aetiological factors in the adult. We report a case of a 21-year-old Nigerian farmer with giant retropharyngeal abscess following fish bone throat injury causing life-threatening upper airway obstruction. The patient responded well to emergency tracheostomy, intraoral surgical drainage and empirical antibiotic therapy. We highlight the diagnostic and therapeutic challenges of managing such a patient.

Traumatic Retropharyngeal Abscess of Insidious Onset—A Case Report and Literature Review

Retropharyngeal abscess is an abscess of the deep spaces in the neck which if not treated urgently can be life-threatening as a result of airway compromise. It is important to detect and treat very early. It may arise in pediatrics from direct neck trauma which is not very common and fishbone impaction. Direct anterior neck trauma resulting in insidious retropharyngeal abscess has not been widely reported.

Retropharyngeal emphysema: An unusual aetiology—A case report and literature review

Introduction: Retropharyngeal emphysema is a potentially life threatening condition which may require urgent diagnosis and intervention. It has been documented to occur following trauma to the aerodigestive tract and is usually accompanied by subcutaneous emphysema of the cervical region. This condition may be complicated by mediastinal emphysema and pneumomediastinum. Foreign body ingestion is quite common in little children and in this environment;a cultural practice is for mothers or other caregivers to attempt to remove these foreign bodies by forcing their finger(s) down the oropharynx and Hypopharynx of these young children. This usually results in injuries to these anatomical sites. Retropharyngeal emphysema complicating this practice is rarely reported. Case presentation: We present the case of a 4-year-old Nigerian boy who presented with stridor and severe dyspnoea following repeated attempts at removal of a purportedly ingested foreign body by his mother. Examination revealed oedema of the soft palate with small multiple bleeding shallow lacerations of the oropharyngeal walls. Oxygen therapy was commenced and preparations for urgent upper airway intervention made. Soft tissue neck X-ray revealed retropharyngeal and subcutaneous emphysema with upper airway compromise. Conservative treatment with high dose steroids and antibiotics led to a gradual resolution of the condition. Conclusion: This is a rarely reported complication of this relatively common socio-cultural “foreign body removal method”. Public awareness is required to stop this potentially life threatening practice.

Spontaneous Retropharyngeal Haematoma in a One-Year-Old Child: A Case Report

Spontaneous retropharyngeal haematoma is an unusual condition and difficult to diagnosis early especially in infants. It has multiple aetiological factors and can present to a number of specialists including the otolaryngologist. We describe an unusual case of a spontaneous huge retropharyngeal haematoma in 1-year-old male child which demonstrates the dramatic presentation and emphasizes the need for immediate surgical approach.

Submandibular retropharyngeal cervical vertebra hook-plate for the treatment of C2 vertebral body tumors

Objective To evaluate the clinical results of sub-mandibular retropharyngeal cervical vertebrahook-plate (RCHP)reconsruction for the treatment of of C2 vertebral body tumors.Methods Nine patents with C2 vertebral body tumors

Kawasaki disease with retropharyngeal edema: case series from a single center experience

To the Editor:Kawasaki disease (KD) and its classical diagnostic criteria are well known to pediatricians nowadays.However,KD can present with substantial overlap of clinical picture with many infectious diseases.Recently it is increasingly recognized that KD can present as pyogenic abscess-like formation with retropharyngeal edema (RPE).As estimated by Yoskovitch et al,[1] 5% of KD presented with some forms of deep neck infection.They could be in various forms,such as peritonsillar abscess,parapharyngeal or retropharyngeal abscess-like edema or acute mastoiditis.Not only do they mimic retropharyngeal abscess clinically,some with incomplete presentation may also contribute to delayed diagnosis and hence timely treatment.In this case series,we reported our experience in managing 24 cases of KD presenting with RPE.

Ultrasound-guided fine needle aspiration of retropharyngeal lymph nodes after radiotherapy for nasopharyngeal carcinoma: a novel technique for accurate diagnosis

Background:Enlarged retropharyngeal lymph nodes(RLNs)are very common in patients with nasopharyngeal carcinoma(NPC)undergoing radiotherapy.The most suitable treatment option for enlarged RLNs depends on the pathological results.However,RLN sampling is difficult and imminent in the clinic setting.We recently developed a novel minimally invasive technique termed endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)for sam-pling RLN tissues sufficient for pathological or cytological diagnosis.Methods:We enrolled 30 post-radiotherapy patients with NPC with suspected RLN metastasis detected via mag-netic resonance imaging(MRI).The EUS probe was introduced into the nasopharynx via the nostrils,and EUS was then used to scan the retropharyngeal space and locate the RLN in the anterior carotid sheath.EUS-FNA was subsequently performed.The safety and efficacy of using EUS-FNA to sample the RLN tissues were assessed.Results:Strips of tissue were successfully sampled from all patients using EUS-FNA.Of the 30 patients,23 were confirmed to have cancer cells in the biopsied tissues via pathology or cytology examinations with 1 EUS-FNA biopsy session.The seven cases without confirmed cancer cells were subsequently reanalyzed by using another EUS-FNA biopsy session,and two more cases were confirmed possessing cancer cells.The other five patients without con-firmed cancer cells were closely followed with MRI every month for 3 months.After follow-up for 3 months,three patients were still considered cancer-free due to the presence of RLNs with stable or shrinking diameters.The rest two patients who showed progressive disease underwent a third EUS-FNA biopsy procedure and were further confirmed to be cancer cell-positive.In the whole cohort reported here,the EUS-FNA procedure was not associated with any severe complications.Conclusion:EUS-FNA is a safe and effective diagnostic approach for sampling tissues from the RLNs in patients with suspected recurrent NPC.

咽旁咽后间隙脓肿并后纵隔脓肿1例

1临床资料 患者,男,34岁。主因＂颈部肿胀进行性加重8 d＂于2008-09-22急诊入院。患者入院前8 d无诱因出现颈部肿胀,于当地医院给予抗炎治疗（具体药物不详）,肿胀无明显改善,并逐渐出现呼吸困难伴进食困难。

鼻咽癌并咽旁咽后脓肿1例

1临床资料患者，男，31岁。因咽痛不适反复发作2年余，现加重伴右侧头痛半个月于2008-04-01入院。自发病加重以来无发热，无鼻塞，无回吸涕中带血，无耳呜、耳闭塞感等。入院前在当地县医院抗感染治疗半个月（用药不详），症状无缓解。专科检查：右侧扁桃体Ⅲ度肿大，舌腭弓、软腭及悬雍垂充血、肿胀，悬雍垂稍偏向左侧；

小儿咽后脓肿临床分析

咽后脓肿多见3岁以下婴幼儿,多由口、咽、鼻腔感染引起,切开排脓是主要治疗措施。对婴幼儿患者,术中快捷安全尤为重要。2004年10月～2010年10月,我院对23例咽后脓肿患儿应用专利手术器械咽后脓肿切吸器及咽后脓肿撑吸器（国家专利号ZL2006 2 0031 366.6,ZL2006 20031367.0）进行手术治疗,均获成功。

Surgical treatment of delayed cervical infection and incomplete quadriplegia with fish-bone ingestion:A case report

BACKGROUND The most commonly ingested foreign body in Asians is fish bone.The vast majority of patients have obvious symptoms and can be timely diagnosed and treated.Cases of pyogenic cervical spondylitis and diskitis with retropharyngeal and epidural abscess resulting in incomplete quadriplegia due to foreign body ingestion have been rarely reported.The absence of pharyngeal or esophageal discomfort and negative computed tomography(CT)findings of fish bone have not been reported.We report the case of an elderly female patient with delayed cervical infection and incomplete quadriplegia who had a history of fish bone ingestion.CASE SUMMARY A 73-year-old woman presented with right neck pain and weakness of four limbs for a week,and had a history of fish bone ingestion and negative findings on laryngoscopic examination one month previously.She did not complain of any pharyngeal or esophageal discomfort.Cervical magnetic resonance imaging showed C4/C5 spondylitis and diskitis along with retropharyngeal and ventral epidural abscesses.No sign of fish bone was detected on lateral cervical radiography and CT scans.The muscle strength of the patient’s right lower limb receded to grade 1 and other limbs to grade 2 suddenly on the 10th day of hospitalization.Emergency surgery was performed to drain the abscess and decompress the spinal cord by removing the anterior inflammatory necrotic tissue.Simultaneously,flexible esophagogastroduodenoscopy was carried out and a hole in the posterior pharyngeal wall was found.The motor weakness of the right lower limb improved to grade 3 and the other limbs to grade 4 within 2 d postoperatively.CONCLUSION This rare case highlights the awareness of the posterior pharyngeal or esophageal wall perforation in patients with cervical pyogenic spondylitis along with a history of fish bone ingestion,even though local discomfort symptoms are absent and the radiological examinations are negative.

Upper Cervical Spine Infection. Complication of Hypopharyngeal Injury

Background: We describe a rare case of Candida albicans retropharyngeal infection with upper cervical spondylodiscitis associated with epidural abscess triggered by ingestion of a chicken bone. Case Description: A 63-year-old woman presented with posterior neck and bilateral shoulders pain three weeks after choking on a 2-centimeter chicken bone. Magnetic resonance imaging (MRI) revealed spondylodiscitis and epidural abscess with significant spinal cord compression at C2 and C3 levels. A Barium swallow showed a focal disruption of the posterior wall of the esophagus. A posterior upper cervical fixation (C2-C5) was initially performed. One week later an anterior decompressive procedure was carried out followed by iliac crest bony fusion, and repair of the esophageal defect. Intra-operative cultures showed heavy growth of Candida albicans. After a transitory post-operative neurologic worsening, and after six weeks of appropriate antifungal therapy, the patient achieved a full clinical and radiologic recovery. Conclusion: Prompt surgical debridement, fusion and stabilization combined with adequate antimicrobial agents are necessary to guarantee a good outcome and reverse the neurological deficits.

Management of pediatric peritonsillar and deep neck infections-cross-sectional retrospective analysis

Objective:Deep neck infections(DNI)are responsible for significant morbidity in children and healthcare expenditures.Few studies exist specifically addressing the clinical and epidemiologic characterization and management of DNI's in the pediatric population.Our goal was to analyse the demographic characteristics,clinical presentation,diagnostic and therapeutic approaches of peritonsillar and DNI in pediatric patients.Methods:The medical records of patients,aged up to 18 years,admitted for peritonsillar and DNI at our department,from 2011 to 2016,were retrospectively reviewed and compared with the literature available.Ninety-eight patients were enrolled.Results:The mean age was higher in patients with peritonsillar abscess and lower in patients with retropharyngeal and parapharyngeal infections.Admissions have significantly increased from 2011.There was a seasonal variation for DNI incidence,with a peak incidence in Summer and Spring.All patients included were treated as inpatient and received empirical intravenous antibiotic therapy and steroids regardless of drainage procedures.Incision and drainage was performed in 72 patients.The hospital length of stay was higher among patients with retropharyngeal abscess and in the group with complications.Only 2 patients developed complications during hospital stay.The most common microbiological pattern was monomicrobial and the most commonly isolated pathogens were Streptococcus Pyogenes,Streptococcus Mitisand anaerobic bacteria.Conclusions:Surgical incision and drainage followed by intravenous antibiotic and steroids proved to be successfull with low morbidity related to surgical approach.However,in selected cases,medical therapy may be an alternative to surgical management in uncomplicated infections.