Observation of Retropharyngeal Fluid Collection in 2 COVID-19 Positive Patients

Abstract

Our understanding of the novel coronavirus, COVID-19, is growing; yet, there remains much we do not understand, and unique presentations are abundant. One potential presentation is retropharyngeal edema, defined as fluid in the retropharyngeal space. Multiplanar imaging with computed tomography or magnetic resonance imaging is ideal for characterizing and diagnosing these fluid collections rapidly as possible life-threatening complications may develop (eg, airway obstruction and mediastinitis). Here, we discuss the presentation, imaging identification, treatment, and recovery of retropharyngeal fluid collection in 2 COVID-19 cases. The significance of this article is to suggest conservative management as a viable treatment option for retropharyngeal fluid collection, as opposed to incision and drainage, in the setting of COVID-19.

Figure 1.

CT Angiogram Head and Neck with and without contrast on 7/21 compared to CT Soft Tissue Neck with and without contrast on 7/24. A, At presentation 7/21 axial view of edematous appearance of the bilateral palatine tonsils and suppurative left retropharyngeal lymph node. Partial effacement of the oropharynx secondary to tonsillar edema. B, At presentation 7/21 sagittal view findings of pharyngitis/tonsillitis, with retropharyngeal effusion extending from the level of C2 to C3 to C7-T1 with maximum thickness of 12 mm. Multiple enlarged retropharyngeal, cervical, and supraclavicular lymph nodes, likely reactive. C, Interval 3-day follow-up 7/24 status post I & D with decreased retropharyngeal fluid collection now measuring approximately 5 mm thickness. CT indicates computed tomography; I & D, incision and drainage.

Figure 2.

CT soft tissue neck with contrast comparison at presentation and 3-day follow-up. Demonstrating retropharyngeal edematous hypodensity extending from the level of C2 to C7. A, Initial imaging 8/18 showing retropharyngeal edema 9 mm in thickness extending from the level of C2 to C7 without rim enhancement, most in keeping with retropharyngeal edema and no definite drainable fluid collection. B, Interval 3-day follow-up 8/21 demonstrated decrease in retropharyngeal/prevertebral hypoattenuation to approximately 4 mm in thickness. CT indicates computed tomography.