Just a sore throat

aka ENT Equivocation 002

A 38 year old male with a background history of type 2 diabetes presents with fevers, rigors and pain on swallowing. There is no sign of impending airway compromise; however, marked trismus is noted.

The following plain X-ray is obtained:

ENT Equivocation 002 retropharngeal abscess

Questions

Q1. What is the likely diagnosis?
Answer and interpretation

There is gross soft tissue swelling evident anterior to the vertebral bodies. The likely diagnosis is retropharngeal abscess.


Q2. What radiological investigation is indicated now?
Answer and interpretation

A CT neck will allow you to determine the extent of the collection and whether it is amenable to drainage.


Q3. Interpret the radiological investigation ordered
Answer and interpretation
ENT Equivocation 002 CT retropharngeal abscess

There is an area of hypodensity in the right posterior pharynx consistent with an abscess.


Q4. The chest X-ray is normal but the ENT surgeon requests a CT chest. What do you think the purpose of this investigation is?
Answer and interpretation

A CT chest is indicated to exclude unappreciated mediastinal mischief due to descending mediastinitis.

This is a rare but highly lethal complication.

Lemierre syndrome is characterized by disseminated abscesses and thrombophlebitis of the internal jugular vein after infection of the oropharynx. The predominant pathogen is a gram-negative anaerobic bacillus, Fusobacterium necrophorum.


References

ENT Equivocation 700

CLINICAL CASES

ENT equivocation

Emergency physician MA (Oxon) MBChB (Edin) FACEM FFSEM with a passion for rugby; medical history; medical education; and informatics. Asynchronous learning #FOAMed evangelist. Co-founder and CTO of Life in the Fast lane | Eponyms | Books | vocortex |

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