Kalmovich Limor Muallem, Gavriel Haim, Eviatar Ephraim, Kessler Alexander
Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Emerg Care. 2012 Aug;28(8):780-2. doi: 10.1097/PEC.0b013e3182627cff.
Significant morbidity and rarely mortality have been described in parapharyngeal space infections in children; hence, the decision on the timing of surgical intervention might be crucial. The aim of this study was to compare the accuracy of plain x-rays, ultrasonography (US), and contrast-enhanced computed tomography (CT) in demonstrating a parapharyngeal abscess.
A retrospective study on all patients with parapharyngeal abscess admitted and operated on from January 1996 to December 2000 was carried out. Charts were reviewed for patients' demographics, symptoms and signs, details of workup, intraoperative findings, and culture results. The CT scans were reviewed for the presence of a rim enhancement, a presence of a definable wall, and fluid-fluid level and were correlated with the plain x-rays and US results and intraoperative findings.
Eighteen patients with proven parapharyngeal infection were included: 10 with proven abscess and 8 with cellulitis. The sensitivity and specificity of lateral neck radiograph and US were low compared with a specificity of 87.5 while evaluating fluid-fluid level seen on the CT scan, sensitivity of 58.3% for the presence of a definable abscess wall, and a sensitivity of 100% for the presence of a prominent wall.
Our study demonstrates good rates of accuracy of CT scan for diagnosing a parapharyngeal abscess. Our study suggest that it is appropriate to obtain a CT scan upon presentation in all children with suspected parapharyngeal abscess and that a CT scan is proven to be a useful diagnostic tool in establishing a treatment plan.
儿童咽旁间隙感染已被描述有显著的发病率，死亡率则很少见；因此，手术干预时机的决定可能至关重要。本研究的目的是比较普通X线、超声（US）和增强计算机断层扫描（CT）在显示咽旁脓肿方面的准确性。
对1996年1月至2000年12月期间收治并接受手术的所有咽旁脓肿患者进行回顾性研究。查阅病历以了解患者的人口统计学资料、症状和体征、检查细节、术中发现以及培养结果。对CT扫描结果进行评估，看是否存在边缘强化、是否有可界定的壁、液-液平面，并与普通X线和超声结果以及术中发现进行对比。
纳入18例经证实的咽旁感染患者：10例经证实为脓肿，8例为蜂窝织炎。与CT扫描上看到的液-液平面评估特异性为87.5%相比，颈部侧位X线片和超声的敏感性和特异性较低，可界定脓肿壁存在的敏感性为58.3%，突出壁存在的敏感性为100%。
我们的研究表明CT扫描诊断咽旁脓肿的准确率很高。我们的研究表明，所有疑似咽旁脓肿的儿童就诊时均应进行CT扫描，并且CT扫描已被证明是制定治疗方案的有用诊断工具。
