PDF(Pubmed)
Abstract：
The incidence of retropharyngeal abscesses has been decreasing since the introduction of antibiotic therapy, and it is currently a rare diagnosis in adults, although there are some recent cases in the literature. Given its seriousness, if not treated promptly, the infection can progress rapidly and its complications can be fatal, making it a serious health problem. A 79-year-old woman presented at her primary care center with complaints of persistent odynophagia for about two weeks and rapidly progressive dysphagia in five days, initially for solids and later for solids and liquids. On observation, she had difficulty swallowing saliva and presented a painful mass in the bilateral anterior submental and anterior cervical region. Due to the rapid progression of symptoms and the findings of the physical examination, the patient was referred to the emergency department for a suspected abscess or cervical mass. In the emergency department, a cervical CT scan was performed, which revealed a retropharyngeal abscess measuring approximately 7 x 6 x 4 cm, involving the right carotid artery and internal jugular vein, with compression of the internal jugular vein. The patient was admitted to the otorhinolaryngology department, where intravenous antibiotic therapy with third-generation cephalosporin and clindamycin was initiated. She underwent exploration in the operating room to determine the cause of the abscess and transoral drainage of the already spontaneously draining abscess. After completing antibiotic therapy, a follow-up CT scan showed complete resolution of the abscess without suggestive masses of neoplasm or foreign bodies, therefore, the cause of the abscess has not been identified. The most frequent cause of retropharyngeal abscess in adults is dental septic foci and another commonly described cause is the ingestion of foreign bodies such as fish bones or chicken bones. Early diagnosis of this condition is crucial, as delays in treatment initiation can lead to the progression of infection into the deep cervical spaces, resulting in serious complications such as mediastinitis, pericarditis, jugular vein thrombosis, sepsis, laryngeal edema, conditions with a high degree of morbidity and mortality. Therefore, it is important for any doctor to be aware of warning signs and symptoms in patients who present such symptoms, especially primary care doctors, who are the first gateway to health services and to whom patients often turn first. This case report shows the importance of suspicion and subsequent referral for timely diagnosis and treatment.
摘要：
自从引入抗生素治疗以来，咽后脓肿的发病率一直在下降，目前在成人中是一种罕见的诊断，尽管文献中有一些最近的案例。鉴于其严重性,如果不及时治疗，感染可以迅速发展，其并发症可能是致命的，使其成为严重的健康问题。一名79岁的妇女在她的初级保健中心就诊，抱怨持续的吞咽困难约两周，并在五天内迅速进行性吞咽困难，最初用于固体，后来用于固体和液体。根据观察,她吞咽困难，并在双侧前下和颈前区出现疼痛性肿块。由于症状的快速进展和体检的发现，患者因疑似脓肿或宫颈肿块被转诊至急诊科。在急诊室，进行了宫颈CT扫描，显示咽后脓肿约7x6x4厘米，累及右颈动脉和颈内静脉,颈内静脉受压.患者入院耳鼻喉科,开始使用第三代头孢菌素和克林霉素进行静脉抗生素治疗。她在手术室进行了探索，以确定脓肿的原因和已经自发引流的脓肿的经口引流。完成抗生素治疗后，随访CT扫描显示脓肿完全消退，无肿瘤或异物提示，因此,脓肿的病因尚未确定。成人咽后脓肿最常见的原因是牙科败血症灶，另一个常见的原因是摄入异物，如鱼骨或鸡骨。这种情况的早期诊断至关重要，因为治疗开始的延迟会导致感染进展到宫颈深间隙，导致纵隔炎等严重并发症，心包炎,颈静脉血栓形成,脓毒症,喉水肿,具有高发病率和死亡率的条件。因此,对于任何医生来说，重要的是要意识到出现这种症状的患者的警告迹象和症状，尤其是初级保健医生，他们是获得医疗服务的第一个门户，病人往往首先求助于他们。此病例报告显示了怀疑和随后转诊对及时诊断和治疗的重要性。
