0:01

I'd like to continue on the subject of the

0:03

retropharyngeal space. Here is a patient,

0:06

a child who is febrile,

0:08

who has a low-density area that is located

0:12

in the retropharyngeal space.

0:14

Retropharyngeal space is usually seen anterior to the

0:18

longus colli, longus capitis muscle complex,

0:21

but posterior to the parapharyngeal space,

0:25

the parapharyngeal fat. In this case,

0:27

we see this low density area.

0:29

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

0:31

This most likely is a necrotic lymph node

0:35

associated with inflammation of the pharynx that

0:38

one sees relatively commonly in children.

0:42

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

0:46

and what we see is a low-density collection that

0:50

is associated with the retropharyngeal space.

0:53

Here's your carotid sheath structure.

0:55

So it's medial to the carotid sheath.

0:57

This is in a typical location for the lateral

1:00

retropharyngeal lymph node.

1:02

And this is not to be called an abscess.

1:05

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

1:09

ring-enhancing lesion.

1:10

It's actually necrotizing lymphadenitis.

1:13

The importance here is that this is an enlarged lymph

1:17

node that has undergone separation

1:20

within the lymph node.

1:21

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

1:25

and therefore we shouldn't call it a retropharyngeal

1:28

abscess. Call it suppurative adenopathy,

1:31

call it necrotizing lymphadenitis of the

1:33

retropharyngeal space. This does not need to be drained.

1:38

Here's another example of a more ill defined

1:42

inflammatory lymph node in the lateral retropharyngeal

1:46

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

1:49

You notice that in close proximity,

1:51

and you can also occasionally get

1:55

inflammatory vasculitis of either the

1:57

jugular vein or the carotid artery.

1:59

It's important to compare the luminal diameter of the

2:03

jugular veins as well as the carotid arteries in these

2:08

cases in order to suggest the possibility

2:10

of a vasculitis in the child.

2:13

Over here,

2:14

to the right side,

2:15

we see multiple other lymph nodes in the jugular

2:19

chains extending back into the posterior jugular

2:22

chains, the level 2B chain,

2:24

which is posterior to the jugular vein

2:27

and that is present bilaterally.

2:29

And this patient basically had a pharyngitis with

2:32

multiple lymph nodes, as well as necrotizing

2:35

lymphadenitis of the retropharyngeal chain.

Case 18 - Retropharyngeal Space

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