Wk 8, Case 2 - Review

Patient History
10-year-old with left neck pain and fever.

Findings
Contrast-enhanced CT was performed from the skull base to the thoracic inlet. The study demonstrates a focal area of decreased attenuation involving the lateral aspect of the left retropharyngeal space associated with diffuse enhancing soft tissue. The coronal images demonstrate inferior extension along the retropharyngeal space. The superior aspect of this extends to just below the skull base. The inferior aspect extends to the level of the soft palate. The focal area of decreased attenuation does not cross the midline and appears lateralized in the left retropharyngeal space in the expected location of the lateral retropharyngeal lymph node. These findings are suggestive of extensive suppurative adenitis involving the left lateral retropharyngeal lymph nodes.

There is diffuse decreased attenuation involving the retropharyngeal space which begins at approximately the level of the oropharynx and extends inferiorly to the level of the hyoid bone. There is a traversing linear vascular structure which approximates the location of the alar fascia. These findings are suggestive of retropharyngeal space edema.

There are multiple enlarged lymph nodes including an approximately 1.7 cm right lateral retropharyngeal lymph node and multiple suboccipital lymph nodes. These can be normal in this age group.

No evidence of aggressive lesions is identified involving the larynx or hypopharynx.

Visualized portion of the brain is grossly within normal limits. However, dedicated brain imaging is necessary for complete diagnostic evaluation.

Visualized portion of the lungs is within normal limits. However, dedicated chest CT is necessary for complete diagnostic evaluation.

Conclusions
1. Findings consistent with extensive left-sided suppurative retropharyngeal adenitis.
2. Diffuse decreased attenuation in the retropharyngeal space with a traversing vascular structure that approximates the alar fascia. These findings are consistent with retropharyngeal space edema (effusion).