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Case 18 - Retropharyngeal Space

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I'd like to continue on the subject of the

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retropharyngeal space. Here is a patient,

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a child who is febrile,

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who has a low-density area that is located

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in the retropharyngeal space.

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Retropharyngeal space is usually seen anterior to the

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longus colli, longus capitis muscle complex,

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but posterior to the parapharyngeal space,

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the parapharyngeal fat. In this case,

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we see this low density area.

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Let's look... and the patient is febrile.

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This most likely is a necrotic lymph node

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associated with inflammation of the pharynx that

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one sees relatively commonly in children.

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Two other examples. In this case, six-year-old child,

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and what we see is a low-density collection that

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is associated with the retropharyngeal space.

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Here's your carotid sheath structure.

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So it's medial to the carotid sheath.

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This is in a typical location for the lateral

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retropharyngeal lymph node.

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And this is not to be called an abscess.

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Despite the fact that it's a well rounded, well defined,

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ring-enhancing lesion.

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It's actually necrotizing lymphadenitis.

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The importance here is that this is an enlarged lymph

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node that has undergone separation

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within the lymph node.

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It's not really an abscess outside the lymph node,

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and therefore we shouldn't call it a retropharyngeal

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abscess. Call it suppurative adenopathy,

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call it necrotizing lymphadenitis of the

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retropharyngeal space. This does not need to be drained.

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Here's another example of a more ill defined

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inflammatory lymph node in the lateral retropharyngeal

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space. Again, here's the carotid sheath structures.

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You notice that in close proximity,

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and you can also occasionally get

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inflammatory vasculitis of either the

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jugular vein or the carotid artery.

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It's important to compare the luminal diameter of the

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jugular veins as well as the carotid arteries in these

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cases in order to suggest the possibility

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of a vasculitis in the child.

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Over here,

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to the right side,

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we see multiple other lymph nodes in the jugular

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chains extending back into the posterior jugular

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chains, the level 2B chain,

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which is posterior to the jugular vein

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and that is present bilaterally.

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And this patient basically had a pharyngitis with

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multiple lymph nodes, as well as necrotizing

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lymphadenitis of the retropharyngeal chain.

Report

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Tags

Neuroradiology

Head and Neck

Emergency

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