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Case Reports
. 2022 Dec 22;10(1):17.
doi: 10.3390/children10010017.

A 5-Year-Old Child with a Deep Neck Abscess Complicated by Laryngeal Obstruction

Armando Di Ludovico  1 , Massimiliano Raso  1 , Paola Di Filippo  1 , Sabrina Di Pillo  1 , Roberta Zappacosta  2 , Giustino Parruti  3 , Pasquale Zingariello  4 , Francesco Chiarelli  1 , Marina Attanasi  1
Affiliations
Case Reports

A 5-Year-Old Child with a Deep Neck Abscess Complicated by Laryngeal Obstruction

Armando Di Ludovico et al. Children (Basel). .

Abstract

Deep neck space infections (DNSI) are defined as infections in the potential spaces and fascial planes of the neck. We show the clinical case of a retro and para-pharyngeal abscess in a healthy 5-year-old child complicated by compression and dislocation of the larynx with marked airway caliber reduction and potentially fatal extension up to the mediastinal aditus. DNSI can occur at any age and, due to its rapid progression, requires immediate treatment in children. In healthy children, concurrent abscesses in separate neck spaces are rare. DNSI recurrence should alert the physician to the possibility of a congenital problem, and if imaging fails, laryngoscopy may be the best diagnostic technique.

Keywords: deep neck space infection; neck abscess; neck pain; torticollis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Neck MRI before treatment. (A) Longitudinal STIR MRI scan of the neck. Voluminous expansive process (32 × 25 × 85 mm Latero-lateral ×Antero posterior ×Cranio-caudal) in the retro and para-pharyngeal spaces with extension up to the mediastinal aditus. (B) Longitudinal T1 MRI scan of the neck. Compression and dislocation to the right of the larynx with marked caliber reduction (maximum diameter of 3 mm at the level of the glottic plane). (C) Longitudinal T1 MRI scan of the neck. Diffuse edema imbibition and contrast impregnation of the lateral and deep muscles and fascial planes of the bilateral cervical region (more evident on the left). (D) Transverse T2 MRI scan. Diffuse edema imbibition and contrast impregnation of the prevertebral fascia, the longus capitis muscle, and the “danger space”. (E) Transverse T1 MRI scan of the neck. Involvement of the left thyroid lobe. (F) Longitudinal T1 MRI scan of the neck. Retro and left parapharyngeal inflammatory collection with residual edema imbibition of the left lateral cervical soft tissues (maximum size of 30 × 21 × 55 mm) between the left thyroid space and the sternocleidomastoid muscle. Reduction in airway dislocation.
Figure 2
Figure 2
Histopathological image. Suppurative inflammatory process (A) involving neck striated muscle fibers, focally destroying and dissociating them (B), and thyroid tissue (C). Neither cellular atypia nor microorganisms were detected.
Figure 3
Figure 3
Longitudinal T1 MRI scan of the neck after treatment.
Figure 4
Figure 4
Transverse T1 MRI scan of the neck after treatment. Absence of para-laryngeal-tracheal fluid collections. Absence of para-laryngeal-tracheal fluid collections.
Figure 5
Figure 5
Case report timeline.
See this image and copyright information in PMC

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