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Welcome Applicants!! 

Welcome Applicants!! . Morning Report January 26, 2012. Retropharyngeal Abscess. Not common, but definitely worth knowing about!!. Submandibular Parapharyngeal * Retropharyngeal* “Danger” Prevertebral Peritonsillar * Parotid Masticator. Facial Spaces.

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Welcome Applicants!! 

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  1. Welcome Applicants!! Morning Report January 26, 2012

  2. Retropharyngeal Abscess Not common, but definitely worth knowing about!!

  3. Submandibular • Parapharyngeal* • Retropharyngeal* • “Danger” • Prevertebral • Peritonsillar* • Parotid • Masticator Facial Spaces

  4. Peritonsillar and Parapharyngreal Spaces

  5. Retropharyngeal Space

  6. Commonly follows URI infection • Tonsillitis • Pharyngitis • Lymphadenitis • Sinusitis • OM • Peak incidence in 3-5 year olds • Also peak age group for numerous viral URIs • Increased number of LN in the retropharyngeal space Epidemiology

  7. POLYMICROBIAL!! • Aerobes • Streptococcus viridans • Group A Streptococcus • Staphylococcus aureus • Staphylococcus epidermidis • Anaerobes • Bacteroides • Fusobacterium • Peptostreptococcus sp. *Microbiology

  8. Neck pain (torticollis) or swelling • Fever • Sore throat • Painful or difficult swallowing • Food refusal • Change in vocal quality • Respiratory distress • Trismus • Chest pain *Clinical Presentation

  9. *Clinical Manifestations

  10. CBC • Blood cultures • Wound culture (if abscess drained) • **If any concern for the patient’s airway, NO labs or imaging until airway is secured** Laboratory Evaluation

  11. *Imaging Studies

  12. Airway, Airway, Airway!! • Antimicrobial therapy • Empiric coverage for GAS, S.aureus (MRSA), and respiratory anaerobes • Ampicillin-sulbactam or Clindamycin* • +/- Vancomycin or Linezolid • +/- Third-generation cephalosporin • Transition to oral ABx can be considered when the patient is afebrile and clinically improved • Total length of treatment: 14 days *Management

  13. Surgical drainage • Indications • Airway compromise* • A large (>2cm) hypodense area on CT scan (?) • Failure to respond to parentralABx therapy* • Debate on how to manage retropharyngeal abscess in patients without airway compromise • Only 25-50% patients require surgery • May be appropriate to wait 24-48h on broad-spectrum ABx to assess need for surgery *Mangement

  14. Airway obstruction • Septicemia • Aspiration PNA • Internal jugular vein thrombosis • Jugular vein suppurativethrombophelbitis • Carotid artery rupture • Mediasteinitis • Atlantoaxial dislocation Complications

  15. A 3 yo boy presents to your office with a 3 day h/o a severe sore throat, decreased PO intake (especially with solid foods), and pain with swallowing. Nothing in his PMHx is noteworthy, and his immunizations are UTD. On PE, the boy in uncomfortable but alert and does not appear toxic. He is sitting upright holding his neck stiffly, and refusing to open his mouth. His temp is 38.6C. He has no LAD, lungs are CTA, there is no heart murmur and no abdominal organomegaly. Of the following, the test MOST likely to confirm this child’s diagnosis is: • A. Cervical LN biopsy • B. CT scan of the neck • C. Laryngoscopic examination of the airway • D. LP • E. Sinus radiograph A Question…

  16. Have a great day! Noon Conference: HTN, Dr. Iorember

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