Cervical Prevertebral Abscess

Case history: A 74-year-old male complaining of from difficulty swallowing, fever and neck pain.

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Figure A: Lateral X-ray of the neck showing widening of the pre-vertebral soft tissue shadow with multiple air densities inside.

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Figure B

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Figure C

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Figure D

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Figure E

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Figure F

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Figures B-G: Axial CT images showing prevertebral cystic lesion with jet black air densities , abutting the vertebral bodies and effacing the pharyngeal air way which displaced anteriorly.

Diagnosis: Cervical prevertebral abscess

Discussion: Retropharyngeal abscess (RPA) produces the symptoms of sore throat, fever, neck stiffness, and stridor. Retropharyngeal abscess occurs less commonly today than in the past because of the widespread use of antibiotics for suppurative upper respiratory infections. Early recognition and aggressive management of retropharyngeal abscess are essential because it still carries significant morbidity and mortality.

The incidence of RPA in the United States is rising, however. Retropharyngeal abscess, once almost exclusively a disease of children, is observed with increasing frequency in adults. Retropharyngeal abscess poses a diagnostic challenge for the emergency physician because of its infrequent occurrence and variable presentation.

CT and MRI are ideal for characterizing and delineating collections. In this pictorial essay, we present the anatomy of the retropharyngeal space and offer a practical approach to evaluating retropharyngeal collections on multiplanar imaging. Important points to remember are that one, a suppurative retropharyngeal node is contained by the nodal capsule; two, a retropharyngeal space abscess is contained only by the fascia of the retropharyngeal space and has the potential for devastating complications from mass effect and the spread of infection; and three, retropharyngeal space edema is noninfectious and resolves spontaneously as its cause is treated.

References:
1. Abdel-Haq N, Quezada M, Asmar BI. Retropharyngeal Abscess in Children: The Rising Incidence of Methicillin-Resistant Staphylococcus aureus. Pediatr Infect Dis J. Jul 2012;31(7):696-9.
2- Lander L, Lu S, Shah RK. Pediatric retropharyngeal abscesses: a national perspective. Int J Pediatr Otorhinolaryngol. Dec 2008;72(12):1837-43.
3-Multiplanar CT and MRI of Collections in the Retropharyngeal Space: Is It an Abscess? Jenny K. Hoang, Barton F. Branstetter, IV, James D. Eastwood and Christine M. Glastonbury. AJR. 2011;Vol.196