6 y/o boy with fever and sore throat

 

Doctor's Information

Name : Morteza
Family : Sanei Taheri
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Samira Shahhamzei

 

Patient's Information

Gender : Male
Age : 6

 

Case Section

Pediatric Radiology

 

Clinical Summary

6 y/o boy with fever and sore throat

 

Images

 

Imaging Procedures and Findings

Lateral neck X-ray : There is a soft tissue mass in oropharynx and hypopharynx with mild airway compression.Due to clinical hx , Parapharyngeal or retropharyngeal abscess is suspicious. CT scan is done . Axial postcontrast CT image shows an irregularly shaped, rim-enhancing fluid collection in the left parapharyngeal space with edema of the surrounding soft tissues, and mild effacement of the airway. significant bilateral cervical adenopathy is evident .(arrows).

 

Discussion

The radiologist needs to 1. distinguish between cellulites(needs medical treatment) and drainable fluid col lection, 2. establish evidence of complication such as vascular compromise or airway compression, and osteomyelitis. CT has been used most commonly in attempting to make this differentiation. On CT,cellulitis appears as an ill-defined area of decreased attenuation with mild, diffuse enhancement and "strandlike" infiltration of surrounding soft tissue. A drainable abscess is seen as a single or multiloculated area of decreased attenuation that conforms to fascial spaces with peripheral rim enhancement of the wall (A complete, circumferential ring of enhancement was the most sensitive finding And air or an air-fluid level within a collection is pathognomonic of abscess). Secondary findings of adjacent myositis, infiltration with stranding of surrounding fat, skin thickening, engorgement of veins and lymphatics, and enhancement of fascial planes can also be seen.

 

Final Diagnosis

Para pharyngeal abscess

 

References

Hagga John R. CT and MRI of the Whole body , 5th edition. P723,724

 

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