Deep Neck Infections: The Daily PANCE Blueprint

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Deep Neck Infections: The Daily PANCE Blueprint

A 4-year-old boy is brought to the emergency department by his parents with a 5-day history of sore throat, nasal congestion, and rhinorrhea. For the past two days, he has had a high fever and increasing neck pain, and he now refuses to eat or drink. His immunizations are up to date. His temperature is 39.5°C (103.1°F), pulse is 130/min, and respirations are 26/min. On examination, he has bilateral anterior cervical lymphadenopathy and significant neck stiffness, refusing to move his neck. Passive extension of the neck is painful. He has a muffled voice, limited mouth opening due to pain, and the tonsils are erythematous with gray exudates but symmetrically enlarged. The uvula is in the midline. Chest auscultation reveals no abnormalities. A lateral neck radiograph shows a widened prevertebral space. What is the most likely diagnosis?

A. Bacterial tracheitis
B. Peritonsillar abscess
C. Epiglottitis
D. Retropharyngeal abscess
E. Acute bacterial cervical lymphadenitis

Answer and topic summary

The answer is D. Retropharyngeal abscess

Retropharyngeal abscess is the most likely diagnosis in this case, characterized by fever, neck pain, refusal to move the neck, muffled voice, and limited mouth opening due to pain. The widened prevertebral space seen on the lateral neck radiograph is a hallmark of retropharyngeal abscess, indicating the presence of an abscess in the retropharyngeal space. This condition is often a complication of upper respiratory infections and requires prompt diagnosis and treatment.

Explanation for Incorrect Answers:

  • A. Acute bacterial cervical lymphadenitis: Characterized by swollen, tender lymph nodes without the significant neck pain, stiffness, or widened prevertebral space seen in this case.
  • B. Epiglottitis: Presents with fever, drooling, stridor, and a “thumbprint sign” on lateral neck radiograph. The patient’s findings are more consistent with retropharyngeal abscess.
  • C. Peritonsillar abscess: Presents with a “hot potato” voice, unilateral tonsillar swelling, and uvula deviation, which are not seen in this patient.
  • E. Viral pharyngitis: Typically presents with milder symptoms such as sore throat and runny nose without the significant neck pain, fever, and radiographic findings seen in this patient.
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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint EENT ⇒ Oropharyngeal disorders ⇒ Diseases of the teeth and gums => Infectious and inflammatory disorders => Deep neck infection

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