0:01

Let's have a look at this patient who had difficulty

0:04

swallowing. The brain images look pretty good.

0:07

The orbits are unremarkable.

0:09

The parotid glands show no abnormalities.

0:12

The nasopharyngeal structures are normal in appearance.

0:15

As we continue down into the, from the oral cavity

0:19

to the oropharynx to the supraglottic larynx,

0:22

were looking pretty good.

0:24

We're down to the aryepiglottic folds and the

0:26

supraglottic larynx, and the pyriform sinus.

0:28

And we notice that there is a low density collection that has

0:33

become apparent behind the esophagus

0:37

in the retropharyngeal space.

0:40

And here is the esophagus.

0:43

Here is the trachea. Here is that low density collection.

0:47

Now, is this just edema?

0:50

Is this a phlegmon?

0:51

Should we call this an abscess?

0:53

We're down in the portion of the retropharyngeal space,

0:56

in the infrahyoid portion of the retropharyngeal

1:00

space where there are no lymph nodes.

1:02

So we say that the retropharyngeal space contains retropharyngeal

1:07

lymphadenopathy to the level of the hyoid bone. Below

1:11

the hyoid bone, in the infrahyoid retropharyngeal space,

1:15

there are no lymph nodes.

1:16

So this is not necrotic lymphadenopathy.

1:18

Is it, however, merely edema,

1:21

or is this a true retropharyngeal abscess/

1:25

phlegmon? Abscess, we usually will look for a peripheral rim enhancement

1:31

and mass effect phlegmon.

1:33

Just sort of a nondescript low-density collection without well

1:36

defined borders, which is what I would probably call this case.

1:40

Notice that we are starting to enter the mediastinum.

1:43

The esophagus remains anterior.

1:45

We're still in the retropharyngeal space,

1:47

anterior to the longus colli, longus capitis muscle complex,

1:50

and we continue into the mediastinum where you continue to

1:54

see this low-density collection. Because it has

1:57

mass effect and is actually lifting the

2:00

esophagus from its normal position, further posterior,

2:04

this does have mass effect.

2:05

So I'm going to call it either a phlegmon or an abscess.

2:08

In this case,

2:09

due to the absence of well-defined borders and enhancing,

2:12

this is going to be termed a retropharyngeal phlegmon.

2:17

You notice that the patient has extensive infiltrates in the

2:21

lung and this was indeed an infectious inflammatory etiology

2:25

in this individual. It ended at approximately T4.

2:30

So first rib, second rib, third rib,

2:34

fourth rib were back to a normal location of the esophagus.

2:39

So in the retropharyngeal space.

Case 20 - Retropharyngeal Phlegmon

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