WIDI - SIMCA0232-Angioedema

SIMCA0232-Angioedema

History

Upper airway distress. Uvular swelling. Evaluate for abscess

Exam

Contrast-enhanced CT of the maxillofacial region and neck 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. 0.5-3.0 mm thick sections were obtained in the axial plane from the nasopharynx to the mid to lower neck and reformatted 3D and/or in the coronal and sagittal planes and viewed interactively at the computer work station.

Prior Study

None

Findings

General

There is general or localized soft tissue swelling involving the deep neck soft tissues. There is no abnormal gas or a foreign body present.

Nasopharynx and Oropharynx

There is mild edema of the walls of the nasopharynx and subtle edema within the adjacent parapharyngeal space resulting in minimal airway narrowing at this level of the pharynx. There is thickening of the oropharyngeal soft tissues including the palatine tonsils, soft palate, uvula, lingual tonsils and posterior pharyngeal wall as well as of the lymphoid tissue along the glossotonsillar sulci. There is also edema within the parapharyngeal and retropharyngeal spaces contributing to mild airway narrowing at this level.

Oral Cavity, Floor of the Mouth, Maxilla and Mandible

There is minimal edema in the mesial aspect of the submandibular space on both sides. There is no endodontal or periodontal disease that might be causing cellulitis or abscess producing secondary airway encroachment.

Major Salivary Glands

There is no evidence of primary sialoadenitis of the major salivary glands secondary edema of those glands contributing to the airway encroachment.

Infrahyoid Visceral Compartment – Larynx & Hypopharynx, Trachea, Thyroid Gland

There is extensive edema and enhancement within the posterior wall of the hypopharynx and the area of aryepiglottic folds producing encroachment on the airway at the level of the upper to mid hypopharynx, as well as the supraglottic larynx.

Retropharyngeal Prevertebral and Epidural Spaces

There is very extensive edema in the retropharyngeal space extending bilaterally into the carotid sheaths contributing to narrowing the lumen of the airway. The retropharyngeal edema extends from the level of the nasopharynx to the lower most scanned levels. There may also be minimal edema within in the prevertebral or paravertebral spaces on the right contributing markedly to narrowing the lumen of the airway. There is no evidence of discitis or osteomyelitis that might be responsible for this edema pattern. The finding is consistent with the edema and findings do not constitute retropharyngeal abscess, as questioned.

Cervical Lymph Nodes

There is no reactive and/or suppurative or neoplastic cervical lymphadenopathy.

Vascular Findings

There is no evidence of thrombus, thrombophlebitis or other occlusive or inflammatory process of the jugular veins or any evidence of arterial inflammation.

Upper Lung Zones and Mediastinum

The study was terminated at the level of the lower neck. If necessary the remainder of the neck can be studied to determine the extent of lower tracheal involvement with edema.

Other

No other significant abnormal findings are present.

Impression

The edema pattern demonstrated within the deep neck soft tissues and visualized portions of the pharynx strongly suggests angioedema due to medications. Such changes are most commonly seen with ACE inhibitors and calcium channel blockers although numerous other medications can produce such angioedema involving the upper airway. The study excludes the suspected retropharyngeal abscess as was questioned. The edema pattern does explain the patient’s airway symptoms.

Recommendations

The Emergency Medical Service was verbally contacted emergently upon initial viewing of this study due to possible progressive airway encroachment that can be associated with drug related airway angioedema.