A 36-year-old woman comes to the emergency department with worsening fever and sore throat. Four days ago, the patient accidentally swallowed a fish bone that scratched her throat and caused some discomfort. She felt better after some time and did not seek medical attention, but for the past 2 days she has had severe sore throat and difficulty swallowing. The patient also reports neck pain and stiffness. Her temperature is 39 C (102.2 F), blood pressure is 126/80 mm Hg, and pulse is 106/min. Examination shows pooling of saliva in the hypopharynx. The posterior pharyngeal wall is red and bulging. The neck is stiff with reduced passive range of motion. Lung auscultation is normal. Lateral radiographs of the neck reveal increased thickness of the prevertebral soft tissues with an air-fluid level. Due to potential contiguous spread of the disease process, this patient is at greatest risk of developing which of the following?

Question

A 36-year-old woman comes to the emergency department with worsening fever and sore throat.  Four days ago, the patient accidentally swallowed a fish bone that scratched her throat and caused some discomfort.  She felt better after some time and did not seek medical attention, but for the past 2 days she has had severe sore throat and difficulty swallowing.  The patient also reports neck pain and stiffness.  Her temperature is 39 C (102.2 F), blood pressure is 126/80 mm Hg, and pulse is 106/min.  Examination shows pooling of saliva in the hypopharynx.  The posterior pharyngeal wall is red and bulging.  The neck is stiff with reduced passive range of motion.  Lung auscultation is normal.  Lateral radiographs of the neck reveal increased thickness of the prevertebral soft tissues with an air-fluid level.  Due to potential contiguous spread of the disease process, this patient is at greatest risk of developing which of the following?

Quizplus · Accepted Answer

11ec25c8_d8c6_1652_bc81_25cf6f25d4fc_MD0003_00 The retropharyngeal space is a deep compartment of the neck defined anteriorly by the buccopharyngeal fascia and constrictor muscles of the pharynx and posteriorly by the alar fascia. It communicates laterally with the parapharyngeal space. This patient has a retropharyngeal abscess with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx. Examination findings can include nuchal rigidity and bulging of the pharyngeal wall. Although deep space infections of the neck have become less common since the advent of widespread antibiotic use, they can progress rapidly with potentially fatal complications. Infection within the retropharyngeal space drains inferiorly to the superior mediastinum. Spread to the carotid sheath can cause thrombosis of the internal jugular vein and deficits in cranial nerves IX, X, XI, and XII. Extension through the alar fascia into the "danger space" (between the alar and prevertebral fasciae) can rapidly transmit infection into the posterior mediastinum to the level of the diaphragm. Acute necrotizing mediastinitis is a life-threatening complication characterized by fever, chest pain, dyspnea, and odynophagia, and requires urgent surgical intervention. (Choice B) Extension of infection from the paranasal sinuses through the underlying bone can lead to subdural empyema. Clinical findings include fever, headache, and mass effect signs (eg, altered mental status). (Choice C) Ludwig angina is a rapidly progressive bilateral cellulitis of the submandibular and sublingual spaces, most often arising from an infected mandibular molar. Clinical findings include fever, dysphagia, odynophagia, and drooling. (Choice D) Cavernous sinus thrombosis is most often due to contiguous spread of infection from the medial third of the face, sinuses, or teeth via the valveless facial venous system. Clinical findings include headache, fever, cranial nerve deficits (eg, diplopia), and proptosis. facial venous system (Choice E) Spinal epidural abscess can be caused by hematogenous dissemination (eg, intravenous drug abuse), contiguous spread from vertebral osteomyelitis, or direct inoculation (eg, epidural anesthesia). Symptoms include fever, focal back pain, and neurologic deficits. Educational objective: Retropharyngeal abscess presents with neck pain, odynophagia, and fever following penetrating trauma to the posterior pharynx. Infection within the retropharyngeal space can drain into the superior mediastinum. Extension through the alar fascia into the "danger space" can transmit infection into the posterior mediastinum and result in acute necrotizing mediastinitis.

A 36-Year-Old Woman Comes to the Emergency Department with Worsening