Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan,
Eur J Pediatr. 2014 Mar;173(3):381-6. doi: 10.1007/s00431-013-2179-0. Epub 2013 Oct 22.
Kawasaki disease with retropharyngeal edema (KD with RPE) is a rare complication, and it is diagnosed by neck CT. Most reported cases had a delayed diagnosis because those patients' conditions were misdiagnosed as retropharyngeal abscess (RPA). The purpose of this study was to differentiate KD with RPE from RPA. We performed a retrospective case-control study comparing children with KD with RPE to those with RPA hospitalized at the tertiary pediatric hospital in Tokyo between 2005 and 2011. The 39 patients revealing RPE on neck CT were divided into two groups: group A was classified as KD (n = 21) and group B was classified as non-KD (n = 18). Patients in group B were finally evaluated as having RPA clinically and were treated with antibiotic therapy. A significantly higher proportion of patients in group B complained of dysphagia (11 patients vs. 5 patients; p = 0.0170) and neck pain (17 patients vs. 12 patients; p = 0.0106). Neck CT revealed a ring enhancement (16 patients vs. no patients; p < 0.0001) and mass effect in a greater proportion of patients in group B (11 patients vs. 1 patient; p < 0.0003).
Careful attention to manifestations and close analyses of CT imaging may allow clinicians to differentiate KD with RPE from RPA.
咽后水肿型川崎病（KD 伴 RPE）是一种罕见的并发症，通过颈部 CT 进行诊断。大多数报道的病例因误诊为咽后脓肿（RPA）而导致诊断延误。本研究旨在区分咽后水肿型川崎病与咽后脓肿。我们对 2005 年至 2011 年期间在东京的一家三级儿科医院住院的伴有咽后水肿的川崎病患儿（n=21）和伴有咽后水肿的非川崎病患儿（n=18）进行了回顾性病例对照研究。将颈部 CT 显示有 RPE 的 39 例患者分为两组：A 组为川崎病（KD）（n=21），B 组为非川崎病（n=18）。B 组患者最终临床诊断为咽后脓肿，并接受抗生素治疗。B 组中有更多的患者主诉吞咽困难（11 例 vs. 5 例；p=0.0170）和颈部疼痛（17 例 vs. 12 例；p=0.0106）。颈部 CT 显示 B 组中有更多的患者存在环状增强（16 例 vs. 无患者；p<0.0001）和肿块效应（11 例 vs. 1 例；p<0.0003）。
仔细观察临床表现并对 CT 影像学进行仔细分析，有助于临床医生区分咽后水肿型川崎病与咽后脓肿。
