A is the correct answer. Why?

Explanation

Missing a retropharyngeal abscess is a pain in the neck! This is a cause of pediatric neck pain that must be considered if something just isn’t adding up in your clinical assessment or if your gestalt is alerting you that something more sinister is lurking around.

Etiology

• Often starts with viral prodrome
• Viral URI → suppurative lymph nodes in retropharyngeal space
• Less commonly trauma (swallowed foreign body, instrumentation)

Clinical findings

• Sore throat
• Neck pain
• Fever
• Dysphagia, odynophagia
• Trismus
• Pain with range of motion
• Decreased range of motion with neck extension
• Dysphonia
• Cervical lymphadenopathy

Diagnosis

• Soft tissue lateral neck X-ray
• May show gas or air-fluid levels in prevertebral space
• Increased thickness of prevertebral space
• High false-positive rate
• CT with contrast is study of choice

Management

• Airway stabilization
• Supplemental oxygen
• Polymicrobial antibiotic coverage (parenteral)
• Clindamycin
• Ampicillin-sulbactam
• Piperacillin-tazobactam
• Admission for medical therapy vs operative intervention

Complications

• Airway obstruction
• Local extension → mediastinitis
• Local extension → atlantoaxial dislocation
• Vertebral osteomyelitis
• Failure of antibiotic therapy