Thomas Ann, Adam Shaun, Goussard Pierre, Venkatakrishna Shyam Sunder B, Andronikou Savvas, Grobbelaar Johan
Department of Otorhinolaryngology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa.
Department of Otorhinolaryngology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa,
Respiration. 2024;103(10):651-659. doi: 10.1159/000540525. Epub 2024 Jul 31.
Most paediatric upper respiratory infections are virally mediated and result in self-limiting reactive lymphadenopathy. In children younger than 5 years, retropharyngeal lymph nodes may give rise to deep neck space infections in this potential space. Retropharyngeal infections are rare after 5 years because lymph nodes undergo atrophy.
We present a series of 6 cases of paediatric retropharyngeal abscesses (RPA) complicated by mediastinitis, managed at a tertiary hospital over a 4-year period.
All our cases presented with fever, difficulty feeding, and neck swelling. The age range was 11 weeks-11 months, and all tested negative for human immunodeficiency virus. The diagnosis and complications were confirmed on computed tomography (CT) scan. The CT scans consistently revealed RPA with varying degrees of deep neck space and mediastinal extension. All children were promptly taken to theatre for source control. Two were extubated successfully immediately after surgery, and the other 4 were extubated in the paediatric intensive care unit, with the longest duration of intubation being 3 days. Methicillin-sensitive Staphylococcus aureus (MSSA) was cultured in all 6 cases.
Management of these cases may be challenging, and young children with RPA require close care and airway monitoring. CT or magnetic resonance imaging is essential to delineate the extent of infection. Surgical drainage should be performed when there is a large abscess, a complication occurs, or an inadequate response in 24-48 h to medical management.
大多数小儿上呼吸道感染由病毒介导，会导致自限性反应性淋巴结病。在5岁以下儿童中，咽后淋巴结可能在这个潜在间隙引发颈部深部间隙感染。5岁后咽后感染很少见，因为淋巴结会萎缩。
我们报告了在一家三级医院4年期间诊治的一系列6例小儿咽后脓肿（RPA）合并纵隔炎的病例。
我们所有病例均表现为发热、喂养困难和颈部肿胀。年龄范围为11周 - 11个月，所有患儿人类免疫缺陷病毒检测均为阴性。通过计算机断层扫描（CT）确诊诊断及并发症。CT扫描始终显示RPA伴有不同程度的颈部深部间隙和纵隔扩展。所有患儿均迅速被送往手术室进行源头控制。2例术后立即成功拔管，另外4例在儿科重症监护病房拔管，最长插管时间为3天。所有6例均培养出对甲氧西林敏感的金黄色葡萄球菌（MSSA）。
这些病例的管理可能具有挑战性，患有RPA的幼儿需要密切护理和气道监测。CT或磁共振成像对于明确感染范围至关重要。当存在大脓肿、发生并发症或对药物治疗24 - 48小时反应不佳时，应进行手术引流。
