CTICasesRetropharyngeal Abscess Progressing to Mediastinitis and Systemic Infection
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Imaging findings
Initial portable radiograph showed effusions, edema, and a widened superior mediastinum. Neck CT revealed a rim-enhancing fluid collection in the retropharyngeal space. Chest CT demonstrated a right paratracheal abnormality with mottled gas, extending inflammation and stranding throughout the middle mediastinum, subtle pleural thickening, and subsequently, flagrant enhancement of visceral compartments and pericardial enhancement, indicating pericarditis and developing pericardial effusion. Lungs showed pneumonia.
Key takeaways
This case demonstrates a rapidly progressing infection originating from a retropharyngeal abscess, which communicated with the mediastinum via loose connective tissue, leading to widespread mediastinitis, bilateral empyemas, pericardial effusion with pericarditis, and endocarditis. The infection was caused by Group C streptococcus, which is normal flora in the mouth and pharynx. The patient, a drug user, presented with retropharyngeal symptoms, dysphagia, and fever, requiring bilateral chest tubes and neck dissection. This highlights the severe and rapid progression of such infections, which can be devastating.
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