0:01

Let's finish our discussion of retropharyngeal collections

0:05

with this classic article written by one of my

0:08

colleagues at Johns Hopkins, Jenny Hong.

0:11

And the article was published in 2011 before she

0:14

came to Hopkins, she was actually at Duke,

0:16

and this is entitled Multiplanar CT and MRI of

0:19

Collections in the Retropharyngeal space: Is it an abscess?

0:22

And she refers to this four step procedure to determine

0:26

whether or not you're dealing with an abscess, a lymph node,

0:29

or just retropharyngeal edema. And she says,

0:32

look at the distribution of the fluid,

0:35

look at the configuration, whether it has mass effect,

0:38

look at whether or not it has a thick enhancing wall,

0:41

and look at ancillary findings.

0:43

So retropharyngeal, by enlarged,

0:46

doesn't have that much in the way of mass effect.

0:48

It kind of fills the retropharyngeal

0:50

space from side to side and

0:52

does not show contrast enhancement, and

0:55

may be secondary to adjacent infections.

0:58

Contrast that with Suppurative

1:00

Retropharyngeal lymph node,

1:02

which you heard me use the term necrotizing lymphadenitis,

1:06

is another term here. It's usually unilateral,

1:09

doesn't cross the midline and more rounded,

1:12

it may have an enhancing wall and look like an abscess

1:15

but it's really just the wall of the lymph node.

1:19

And usually, it's a secondary reactive

1:21

lymph node to adjacent pharyngitis.

1:25

The final entity is the retropharyngeal abscess.

1:28

Remember, this is one that crosses the midline,

1:30

goes from side to side.

1:32

If it's unilateral,

1:34

probably a lymph node. If it's going into the midline or

1:38

crossing from side to side, more likely to be an abscess,

1:42

has mass effect, has an enhancing wall, and again,

1:45

may have the same thing,

1:46

a tonsillitis or a pharyngitis as

1:48

the initial ideology of that.

1:51

What Jenny did not refer to in this article is a phlegmon.

1:55

And that's sort of this transition

1:57

zone between retropharyngeal edema

2:00

and abscess. The phlegmon will have mass effect.

2:03

It will expand the retropharyngeal space.

2:07

It does look like a localized collection,

2:09

and yet it does not have a peripheral enhancing wall, and

2:14

it does not have such well-defined borders

2:17

as you would see with a retropharyngeal abscess.

2:20

The final thing I want to mention about the retropharyngeal

2:22

space, is this concept of the danger space.

2:26

So the danger space is a reflection of the fascia

2:30

that also encloses the retropharyngeal space.

2:33

And the difference being that the retropharyngeal space,

2:38

as you see depicted in this diagram,

2:41

extends to the T3, T4 level, down here.

2:45

Whereas, the danger space is the space that's in purplish,

2:49

dark purple, that actually expands and can extend to the

2:53

inferiormost portion of the thoracic cavity,

2:56

and even down to the diaphragm in its location.

3:00

So these are reflections of, in general,

3:03

what we call the Alar fascia, that separates and distinguish

3:08

retropharyngeal space versus danger space.

Case 20 - Retropharyngeal Space Collections

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