0:01

I've shown numerous examples

0:03

of retropharyngeal lymph nodes,

0:05

including those that are suppurative or necrotizing,

0:08

as being a differential diagnosis

0:12

of a retropharyngeal abscess. Now,

0:14

it is true that most cases of retropharyngeal abscess

0:19

represent rupture of those lymph nodes into the

0:22

retropharyngeal space and out of the lymph

0:25

node into the adjacent tissue.

0:27

Because the retropharyngeal lymph nodes

0:29

are usually on either side of the midline,

0:32

we say that when you do see a low

0:34

density collection in the midline,

0:37

it's more likely to represent a true

0:39

retropharyngeal abscess that has left the adjacent lymph

0:44

nodes. And this is a good example of that.

0:47

So here we have a child who was having

0:50

difficulty breathing and was febrile.

0:54

And as we come into the nasopharynx,

0:57

we see that there is obliteration of the

1:01

nasopharyngeal airway with lymphoid hyperplasia of the adenoidal

1:05

tissue. Here we are in the retropharyngeal space.

1:08

The retropharyngeal space, remember,

1:10

is anterior to the longus colli and longus colli capitis

1:13

muscle complex. So this is in the retropharyngeal space.

1:17

In this case,

1:18

the inflammatory collection is actually perforating into

1:22

the pre vertebral space in front of the vertebral body,

1:25

and actually affecting the longus colli musculature.

1:28

But more importantly,

1:29

this is a collection that crosses the midline.

1:32

Since there are no retropharyngeal lymph

1:34

nodes that cross the midline,

1:36

this is really a nice example of what is termed

1:41

a retropharyngeal abscess as opposed to the

1:44

retropharyngeal necrotic lymphadenopathy .

1:48

You notice that the patient indeed does have multiple

1:52

lymph nodes here and there is an inflammatory process

1:55

which is extending into the region of the sternocleidomastoid

1:58

muscle and the deep spaces of the neck, with

2:01

secondary involvement of the carotid sheath structure.

2:04

But this collection, which crosses the midline, should

2:08

be termed a retropharyngeal abscess as opposed to

2:12

the necrotic lymphadenopathy off on the side.

2:15

And this patient required intubation to protect the

2:21

airway because these collections may extend and

2:25

lead to narrowing of the airway

2:27

and respiratory compromise.

2:30

Something of interest about the retropharyngeal space.

2:33

The retropharyngeal space can extend from the nasopharyngeal

2:37

level all the way down to the

2:40

T6 to T9 thoracic level.

2:43

And therefore you can have extension of these

2:46

inflammatory collections even into the upper

2:50

chest structure to the mid-chest structure.

2:52

Look how low we are going.

2:54

So this is all continuous from the

2:57

retropharyngeal of the nasopharynx, down

3:00

to the inferior neck,

3:02

and we still see it even into the mediastinum if we

3:06

count the ribs. Rib 1, rib 2, rib 3, rib 4,

3:11

rib 5, rib 6,

3:13

and we still have that low density collection

3:16

in the retropharyngeal space. Interestingly,

3:20

there is a reflection of the retropharyngeal

3:23

space called the danger space.

3:26

This is due to a reflection of the alar fascia,

3:30

which makes up a border of the retropharyngeal space.

3:33

The danger space can extend even to the

3:37

diaphragm at the base of the chest.

3:41

So retropharyngeal inflammatory processes that

3:46

perforate into the adjacent danger space could

3:51

extend from the nasopharynx all the way

3:53

down to the diaphragm of the thorax.

Case 19 - Retropharyngeal Abscess

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