Case 20 - Retropharyngeal Phlegmon

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

PROCEDURE: CT HEAD/BRAIN W/WO CONTRAST, CT T-SPINE W/ CONTRAST COMPLEX, CT NECK SOFT TISSUE W/ CONTRAST COMPLEX

PRIOR STUDIES: CT head and CT chest, abdomen, and pelvis from 9/9/2018.

CLINICAL HISTORY: MRSA endocarditis, concerning for septic emboli. Status post tricuspid valve replacement 9/10/2018.

TECHNIQUE: CT of the head performed without and with intravenous contrast. Soft tissue neck CT and thoracic spine CT performed with intravenous contrast.

FINDINGS:

Head CT: There is no acute intracranial hemorrhage, mass, infarct, or fluid collection. The ventricles are normal. Basilar cisterns are patent. No midline shift or herniation. There is no abnormal enhancement.

Calvarium is intact. Mastoid air cells are clear. Small amount of secretions noted in the sphenoid sinus. Orbits are unremarkable.

Unchanged compared to the exam from 9/9/2018.

CT soft tissue neck: Motion degrades this exam.

Within the posterior right paraspinous of the neck at the right C5 level is a 0.9 x 0.6 x 1.3 cm (AP, transverse, craniocaudal) peripherally enhancing fluid collection.

There is a peripherally enhancing fluid collection between the esophagus and the vertebral bodies extending from the C5-T2 levels measuring 1.8 x 3.3 x 8 cm (AP, transverse, craniocaudal).

No additional fluid collections are identified in the soft tissues of the neck. Nasopharynx and oropharynx appear within normal limits.

There is a right-sided central venous catheter noted. The vascular structures are otherwise unremarkable.

There are multiple missing teeth and dental caries noted. The parotid and submandibular glands are within normal limits. 5 mm right thyroid nodule noted. Thyroid is otherwise unremarkable.

No osseous erosions identified of the cervical spine.

Thoracic spine:

The vertebral body heights, alignment, and disc spaces are normal. There are no osseous erosions identified. There is no fracture.

Bilateral loculated pleural effusions and a left hydropneumothorax noted and will be better characterized on full field CT chest performed concurrently. The retroesophageal abscess is again noted. There are extensive multifocal opacities in the lungs also will be better characterize on the CT chest.

IMPRESSION:

No acute intracranial abnormality.

There is a large retroesophageal retropharyngeal space peripherally enhancing fluid collection concerning for abscess. This extends from approximately the C5-T2 levels.

Additional small abscess in the right posterior paraspinal musculature cervical soft tissues at approximately the C5 level.

Extensive infiltrates and pleural collections bilaterally, right worse than left.

No CT evidence for discitis or osteomyelitis.