WIDI - CA0148-Retropharyngeal Abscess Due to Foreign Body Perforation, CT

Retropharyngeal Abscess Due to Foreign Body Perforation, CT

Claim CME Credit

0.5 CME Credit available on completion

POINT OF CARE INFORMATION

This CME activity consists of the student reviewing the video of the professor reviewing the case as well as the associated DICOM image set related to the case in question.

Learning Objectives

As a result of participation in this activity, participants should be able to:

Provide improved patient care.
Greater knowledge of the imaging characteristics of the patient's disease.
Understand a better approach to interpretation of studies.

Faculty Disclosure

Mehmet Albayram, MD, Ivan Davis, MD, Mariam Hanna, MD, Anthony Mancuso, MD, Ronald Quisling, MD, Dhanashree Rajderkar, MD, Priya Sharma, MD, Roberta Slater, MD and Joann Stamm, MBA have disclosed that they have no relevant financial relationships. No one else is a position to control content have any financial relationship to disclose.

CME Advisory Committee Disclosure:

Conflict of interest information for the CME Advisory Committee members can be found on the following website: https://cme.ufl.edu/disclosure/.

Continuing Medical Education Credit

Accreditation: The University of Florida College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Credit: The University of Florida College of Medicine designates this enduring material for a maximum of 0.5 AMA PRA Category 1 Credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

CA0148-Retropharyngeal Abscess Due to Foreign Body Perforation, CT

History

Young child in the emergency room with fever and refusing to eat and neck pain. Possible pharyngitis and retropharyngeal abscess.

Exam

Contrast-enhanced CT of the maxillofacial region and neck and related anatomy with images obtained in the balanced or venous vascular phase to ensure optimal visualization of both arterial and venous structures as well as possible reactive changes around infected collections. 0.5-3.0 mm thick sections were obtained in the axial plane and reformatted 3D and/or in the coronal and sagittal planes and viewed inter actively in 3 dimensions at the computer work station.

Prior Study

N/A

Findings

General

There is soft tissue swelling of the neck mainly on the left both around the pharynx and in the deep neck. There is a related abscess and radiodense body present. These findings are discussed in more detail subsequently.

Nasopharynx including retropharyngeal lymph nodes

The posterior pharyngeal wall is thickened and there is evidence of a retropharyngeal abscess on the left and involving the lower oropharynx added below the level of the tonsil.

Hypopharynx, larynx, deep neck and entire retropharyngeal space

There is extensive edema involving the hypopharynx more on the left than right. There is a radiodense foreign body of about 2 cm in length on the left side in the retropharyngeal space within a multi-loculated abscess. The abscess is confined to the retropharyngeal space and does not involve the prevertebral or deep neck spaces. The abscess measures about 26 x 16 x 40 mm.

Cervical Lymph Nodes:

There is reactive cervical lymphadenopathy in level 2-3 on the left. There is no suppurative cervical lymphadenopathy.

Vascular findings

There is no evidence of thrombus, thrombophlebitis or other occlusive or inflammatory process of the jugular vein or smaller venous tributaries.

There is no evidence of thrombus, inflammation of the common, external or internal carotid artery. There is no evidence of active extravasation or a contained leakage from an arterial source.

Impression

Retropharyngeal abscess due to oropharyngeal perforation with a retained foreign body.

Recommendations

The emergency medical service was contacted verbally with these critical findings at the time of completion of the study. They were advised of the perforation and the retained foreign body and a history of this child self-injuring his oropharynx with a pencil was forthcoming.