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  • Posted by Unknown Member on November 19, 2020 at 2:35 pm

    Isolated retropharyngeal edema, no abscess on CT neck with contrast. 
     
    Pharyngitis with reactive edema? We did CT chest. No significant extension.
    No fever or white count but pain and difficulty swallowing. ENT choosing to manage conservatively with antibiotics for now.
     
    Anyone seen this?
     
     

    Unknown Member replied 3 years, 7 months ago 8 Members · 15 Replies
  • 15 Replies
  • clickpenguin_460

    Member
    November 19, 2020 at 3:15 pm

    It wasn’t calcific tendinitis of longus colli?
     
    [link=https://radiopaedia.org/articles/calcific-tendinitis-of-the-longus-colli-muscle-2?lang=us]https://radiopaedia.org/a…colli-muscle-2?lang=us[/link]

    • Unknown Member

      Deleted User
      November 19, 2020 at 3:33 pm

      LOL. The ENT brought that up. No calcification so less likely.

      • Unknown Member

        Deleted User
        November 19, 2020 at 4:09 pm

        I’ve seen the same findings on MRI. 
        I think its related to the above/hydroxyapatite more than we know. They have neck pain, but no signs of infection. I always check for calcification if there is a ct; but mostly negative; still I bet there are plenty of cases without CA++. 

        • stlmchenry_510

          Member
          November 20, 2020 at 3:10 am

          I think so too

          • samsone_882

            Member
            November 20, 2020 at 4:34 am

            Yes, seen prob 8-10 cases like this, some without and some with mild leukocytosis. Half in peds, half in young adults.

            I prob learned the concept of it incorrectly, saw my first few cases clustered together in residency and in my kind equated it on the spectrum of the step before retropharyngeal abscess

            Maybe seen it with more frequency because our ED non-physician providers and some docs will CT anyone with a pulse / sore throat? Other than the young age, Ive never associated it with another demographic factor or association, usually just young people with sore throat / URI and difficulty swallowing

            • samsone_882

              Member
              November 20, 2020 at 6:12 am

              **in my mind – my mobile browser (and more likely technical ineptness) isnt letting me edit the above

            • Unknown Member

              Deleted User
              November 20, 2020 at 8:40 am

              Quote from Rad1Brad

              Yes, seen prob 8-10 cases like this, some without and some with mild leukocytosis. Half in peds, half in young adults.

              I prob learned the concept of it incorrectly, saw my first few cases clustered together in residency and in my mind equated it on the spectrum of the step before retropharyngeal abscess

              Forme fruste of retropharyngeal abscess? How were they managed? Antibiotics with close follow up? Did any progress to abscess?

              • Unknown Member

                Deleted User
                November 20, 2020 at 9:04 am

                As above, I’ve seen it in adults with neck pain.
                We are talking minimal fluid/edema.
                No signs of infection. but definite pain.
                Normal C spine o/w.
                Could it be forme fruste of retropharyngeal abscess; of course.
                But I don’t think so; I believe inflammatory, but not infectious, and think more in the line of mild or early hydroxyapatite dz.
                Who knows, but I have not seen it develop into something bad.
                Just my anecdotal experience.
                 

                • samsone_882

                  Member
                  November 22, 2020 at 4:05 am

                  For follow-up — most were just discharged from the ED never to be heard of again. One or two had ENT consult, follow-up, and follow-up imaging pursued and it went away. All had antibiotics for management, not quite sure if it’s a prelude to a retropharyngeal abscess. No c-spine issues in the ones I’ve seen. Maybe something in the water where I practice, ha 

                  • msc5405

                    Member
                    November 22, 2020 at 7:59 am

                    Serositis from something like lupus? SVC syndrome?

                    • Unknown Member

                      Deleted User
                      November 22, 2020 at 8:46 am

                      Great discussion

                    • aaco

                      Member
                      November 22, 2020 at 12:38 pm

                      volume overload
                       
                       

                    • Unknown Member

                      Deleted User
                      November 23, 2020 at 12:16 pm

                      Quote from MODIOLUS

                      volume overload

                      I see volume overload all the time. It is diffuse, not local or isolated to the retropharyngeal space.
                       
                      I thought about isolated angioedema but no epiglottic, aryepiglottic fold or uvular edema so unlikely.

                    • seb_arrosa_904

                      Member
                      November 24, 2020 at 9:43 am

                      don’t forget normal variants like maga epiglotis etc among  many other normal or borderline variants in addition to very  common artifact from dental hardware which can make  Ct neck reading exceedingly  difficult

                    • Unknown Member

                      Deleted User
                      November 24, 2020 at 10:17 am

                      Saw a retropharyngeal hemangioma once. Rad called retropharyngeal abscess. ENT loved that one.