Case 19 - Retropharyngeal Abscess

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAM: CT NECK SOFT TISSUE W/ CONTRAST COMPLEX

INDICATION: Follow-up 9-month-old with retropharyngeal abscess.

COMPARISON: CT 2/6/2018.

TECHNIQUE: Following IV administration of iodinated contrast, soft tissue neck CT with sagittal, coronal reformats were obtained.

FINDINGS: Patient is now intubated and there is an NG tube present.

There is redemonstration of fluid collection in the deep neck similar in configuration and extent compared to the prior CT from 2/6/2018, however now has more well-defined borders compatible with abscess.

This is primarily centered in the retropharyngeal space eccentric to the left extending inferiorly into the posterior mediastinum, with the visualized extent measuring approximately 1.3 x 2.2 x 7.8 cm (AP by TV by CC), with the inferior extent further defined on subsequent chest CT.

There is extension into the left lateral paraspinal and parotid spaces, coursing anterior to the carotid sheath just below the bifurcation, which is difficult to measure but approximately 2.5 x 1.7 x 1.6 cm. This collection abuts and possibly extends into the left sternocleidomastoid muscle.

There is additional extension of the retropharyngeal collection in the left supraclavicular space, measuring approximately 1.3 x 2.6 x 1.6 cm.

There is extension along the lateral margin of left lobe of thyroid gland into the anterior mediastinum.

There is a low-density collection with substantial mass effect on the left innominate vein (series 2 image 38) versus intraluminal thrombus, similar to the prior study.

There is an enlarged enhancing lymph node in the posterior left neck measuring 1.6 x 1.2 cm (series 2 image 17).

Orbits appear unremarkable. Retained secretions within the nasal cavity. Paranasal sinuses are not yet well-developed. Trace effusions in the bilateral mastoid air cells. Middle ears appear clear. No suspicious osseous lesion or demineralization.

Limited evaluation of visualized intracranial contents is unremarkable.

Cervical and upper thoracic spinal canal is patent. Visualized vertebral bodies and disc spaces are intact.

Partially visualized lungs demonstrate new bilateral pleural effusions and atelectasis, please see separate chest CT report.

IMPRESSION:

Grossly unchanged size and extent of lobular fluid collection centered in the retropharyngeal space, extending into the mediastinum, with multifocal extension into the left neck as described above. The margins are better defined compared to 2/6/2018 likely reflecting organizing abscess.

Possible thrombus in the left innominate vein similar to prior study.

New bilateral pleural effusions and atelectasis in the visualized upper lung fields, please see separate chest CT report.