Case Files 3 - Peds: I'm Hot and Drooling Over You (Answers)

1. D. The patient should be admitted for intravenous antibiotics and surgical consultation
   
   
2. Diagnosis: Retropharyngeal abscess
   
   
3. On physical examination, one might see bulging of the posterior pharyngeal wall, although given the age of the involved patients and the likely difficulty of the examination, this may not be obvious. Involved organisms are most commonly group A Streptococcus, Staphylococcus aureus, and the anaerobes that occupy the oral cavity.
   
   "Tracheal rock sign" elicits pain while gently moving the larynx and trachea from side to side. These patients prefer to lie supine with their necks extended, maximizing their airway patency. Sitting up or flexing their necks worsens their respiratory distress.
   
   
4. Radiographic evaluation of children with the above complaints mandates differentiation of RPA from other etiologies including:
   
   • epiglottitis
   • foreign body aspiration
   • meningitis
     
   
   Computerized tomography (CT) scanning with contrast is frequently used to further characterize the nature of the swelling and is more sensitive in evaluating the difference between cellulitis and true abscess.

Source: Med Case Reports