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March 2006 Radiology Answer Key
This patient is a 5 year old male who presents to the emergency department with the chief complaint of fever, wheezing and sorethroat. The following x ray is shown.
Questions:
1. Describe what you see?
- Soft tissue swelling of the retropharyngeal space
- Diagnosis: Retropharyngeal abscess
2. How do these patients present? (signs and symptoms)
- · Symptoms in infants and children
- · Sore throat
- · Fever
- · Neck stiffness or swelling
- · Odynophagia
- · Cough
- · Poor oral intake
- · Rhinorrhea
- · Lethargy
- · Cough
- · Physical signs in infants and children
- · Fever
- · Stridor
- · Drooling
- · Lethargy
- · Cervical adenopathy
- · Retropharyngeal bulge
- · Torticollis
- · Neck stiffness
- · Agitation
- · Neck mass
- · Lethargy
- · Respiratory distress
3. What would be your management for the above patient?
- · Airway management
- · Apply supplemental oxygen.
- · Endotracheal intubation may be required if the patient has signs of upper airway obstruction.
- · Cricothyrotomy (surgical or needle) or Tracheostomy may be required in the patient with upper airway obstruction who cannot be intubated.
- · Intravenous fluids are required if the patient is dehydrated because of fever and difficulty swallowing.
- · Intravenous antibiotics such as Clindamycin, Penicillin G and metronidazole (Flagyl), Cefoxitin (Mefoxin), Ticarcillin and clavulanate (Timentin) or Piperacillin and tazobactam (Zosyn)
- · Consultations: An emergent consultation with an ear, nose, and throat (ENT) specialist ASAP. If an abscess is present, an ENT specialist can drain it in the operating room.
- Trivia: Name the artist and the song
Look out, Mama,
there's a white boat
comin' up the river
With a big red beacon,
and a flag,
and a man on the rail
I think you'd better call John,
'Cause it don't
look like they're here
to deliver the mail
And it's less than a mile away
I hope they didn't come to stay
It's got numbers on the side
and a gun
And it's makin' big waves.
- Answer: Neil Yong -"Powderfinger"
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