A Pediatric Case of Retropharyngeal Lymphadenitis

Retropharyngeal abscess which is usually seen in children under 6 years of age is a serious complication of pharyngeal infection. We described retropharyngeal lymphadenitis of an eight-year-old boy who was misdiagnosed as having a retropharyngeal abscess. On May 12th, 2000, he was admitted to our hospital for pain and swelling of the left neck and trismus. Contrast-enhanced CT showed 20×25mm low attenuation mass with ring enhancemant on the left side of the retropharyngeal space and a low density mass in the retropharyngeal area. Surgical drainage was performed, but there was no pus recognized. The patient also had multiple swollen cervical lymph nodes, and a biopsy was performed on one of them. The pathological diagnosis was reactive lymphadenitis. The patient responded to antibiotic therapy. In children under 6 years of age, lymph nodes in the retropharyngeal space are well developed compared with those of adults. For this reason, retropharyngeal abscess more easily occurs in children than adults. Published CT criteria for diagnosis of retropharyngeal abscess have included focal low attenuation mass sometimes with ring enhancement. In this case, the reason why a retropharyngeal abscess was thought possible was that contrast-enhanced CT of lymphadenitis demonstrated an image resembling deep neck abscess. Glasier et al reported that ultrasound (US) was useful in distinguishing retropharyngeal abscess from adenitis in children. When a diagnosis is difficult, US examination should be performed to correctly diagnose the condition and avoid unnecessary surgical intervention in children with retropharyngeal adenitis without abscess.