CASUISTIC CASE OF RETROPHARYNGEAL ABSCESS WITH AN ATYPICAL CLINICAL PICTURE IN A CHILD

Abstract

Retropharyngeal abscess is an acute purulent inflammation of the lymph nodes and loose tissue of the pharyngeal space. The pharyngeal space spans from the base of the skull to the lower edge of the pharynx. It is bounded anteriorly by the posterior pharyngeal wall and posteriorly by the prevertebral fascia. Laterally, it is bounded by the parapharyngeal spaces and the neurovasc ular bundles of the neck, and it extends into the posterior mediastinum inferiorly., which facilitates the spread of abscess into the mediastinum, causing mediastinitis. The lymph nodes of the pharyngeal space are regional to the nasopharynx, oropharynx, posterior nasal cavity, auditory tube, and tympanic cavity. Therefore, the causative factors of retropharyngeal abscess are inflammatory diseases of the upper respiratory tract and middle ear. Retropharyngeal abscess is an extremely serious pathology of early childhood and is observed in children of the first 4 years of life. In children over the age of 4, it practically does not occur due to regression and obliteration of the lymph nodes and regression of the pharyngeal space. We have described a clinical case of the retropharyngeal abscess in a child aged 4 years and 10 months, the symptoms and course of which are radically different from the classic symptoms of this pathological condition in children of early childhood. In the differential diagnosis of the retropharyngealt abscess it is necessary to distinguish it from a number of diseases, namely ARVI, acute nasopharyngitis, tonsillitis, including lingual and pharyngeal tonsils, stomatitis, paratonsillitis, paratonsillar abscess, Ludwig's angina, parapharyngeal phlegmon, phlegmon of the neck, mononucleosis, acute stenosing laryngotracheitis, acute subglottic laryngitis (pseudocroup), pneumonia,cervical lordosis, aneurysm of ascending aorta or cervical artery, tumors of the nasopharynx, foreign bodies of pharynx, larynx, and cervical esophagus. Complications make this disease extremely dangerous. The most common complications are observed in the second week of the disease in cases of undiagnosed process, namely laryngeal oedema with development of acute stenosis, pneumonia, sepsis, meningoencephalitis, spread of inflammation to the interfascial space of the neck and posterior mediastinum with development of purulent mediastinitis and varrious septic complications. The most unexpected and dangerous complication is death by asphyxia, which occurs when the abscess opens spontaneously due to aspiration of pus. Thus, retropharyngeal abscess occurs mainly in early childhood due to the peculiarities of the anatomical structure of the pharyngeal space, loose tissue and lymph nodes. These anatomical features of the pharynx and pharyngeal space in childhood and the causative factors should be taken into account by the doctor in case of any deterioration of the child's general condition accompanied by hyperthermia, impaired breathing and swallowing difficulties. However, the less frequent but possible occurrence of a retropharyngeal abscess with atypical clinical symptoms after the age of 4 years should not be forgotten. The Commission on Biomedical Ethics of the BSMU of the Ministry of Health of Ukraine (Chernivtsi) determined that the study was conducted in compliance with the "Rules of Ethical Principles for Scientific Medical Research Involving Human Subjects" approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), Regulation (EU) No. 609 of 24 November 1986, and Orders of the Ministry of Health of Ukraine No. 690 of 23 September 2009, No. 944 of 14 December 2009, No. 616 of 03 August 2012. The material presented in this article may be recommended for publication (Protocol No. 7 of 18 May 23).

Keywords

• Pharynx; Retropharyngeal Space; Abscess; Hyperthermia; Childhood; Opening; Drainage; Therapy.