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Age: 9 months

Sex: Female

Indication: Fever, concern for retropharyngeal abscess

Save ("V")

Case #20


Findings

  • Peripherally enhancing fluid collection in the left neck centered near the carotid space
  • Ill/defined fluid extends within the carotid sheath inferiorly into the upper mediastinum without well-defined mediastinal collection, though the mediastinum is incompletely evaluated
  • Retropharyngeal edema without retropharyngeal abscess
  • Mass effect upon and narrowing of the oropharynx and left internal jugular vein, both of which remain patent
  • Reactive cervical lymphadenopathy


Diagnosis

  • Suppurative lymphadenitis with descending mediastinitis

Sample Report

Left neck abscess measuring 2.5 x 2 x 2.5 cm centered near the carotid space with inferior extension through the carotid sheath into the upper mediastinum, consistent with descending mediastinitis. No well-formed superior mediastinal abscess, though the mediastinum is incompletely evaluated. Consider chest CT with contrast to further evaluate the extent of infection. Mass effect on the oropharynx and left internal jugular vein, both of which remain patent.

Retropharyngeal edema without abscess.

Reactive cervical lymphadenopathy.


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Images

Red arrows: fluid extending inferiorly through the carotid sheath separating the carotid artery (medially) from the internal jugular vein (laterally). Note the mass effect on the internal jugular vein. Red arrows: retropharyngeal edema.



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