Wk 2, Case 4 - Review

Patient History
Fever. Left-sided throat pain.

Findings
Contrast-enhanced CT of the neck demonstrates an extensive abnormality involving the left oropharynx which partially effaces the adjacent airway. There is diffuse soft tissue swelling of the left tonsil that extends superiorly to involve the soft palate and left half of the nasopharynx. The involvement of the soft palate extends medially to involve the tip of the uvula. The diffuse edema extends inferiorly to involve the left glossotonsillar sulcus, left pharyngoepiglottic fold and left piriform sinus. The involvement of the left pharyngoepiglottic fold appears to extend medially to involve the free margin of the epiglottis. There are some focal areas of low attenuation involving the left tonsillar region that extend to the soft palate that could represent early abscess. However, this may also represent a substantial amount of phlegmon. There is some edema involving the retropharyngeal space.

There are multiple prominent lymph nodes seen throughout both sides of the neck. The largest measures approximately 1.7cm and left level 2.

Visualized portion of the brain is within normal limits. Visualized portion of the lungs are within normal limits.

Conclusions
1. Diffuse soft tissue abnormality likely representing extensive phlegmon partially effacing the airway that is centered in the left tonsil that extends superiorly to involve the left half of the nasopharynx and inferiorly to involve the left glossal tonsillar sulcus and piriform sinus. There is associated involvement of the uvula and free margin of the epiglottis. There are some subtle focal areas of low attenuation within this large soft tissue abnormality that could represent early abscess. However, it is possible this also represents diffuse soft tissue phlegmon and early suppuration without the formation of well-defined abscess.
2. Multiple prominent lymph nodes the largest of which measures 1.7cm and left level 2.