Pediatric retropharyngeal lymphadenitis: differentiation from retropharyngeal abscess and treatment implications.

OBJECTIVES: Our objectives were to review the retropharyngeal anatomy, define retropharyngeal adenitis and abscess, and determine if CT may guide the clinician in treatment planning for pediatric retropharyngeal infections.

STUDY DESIGN AND SETTING: A retrospective chart review and CT scan review of 30 children with retropharyngeal infections.

RESULTS: All patients had retropharyngeal adenitis. Average volume of the low-attenuation focus in the medical treatment group was 1.2 cm3. Average volume in the surgical group was 4 cm3. Surgery patients with no purulent findings were then grouped with the medical treatment group; the average volume of the low-attenuation focus in this group was 2.2 cm3. Average volume in the group in which purulence was identified was 4.4 cm3.

CONCLUSION: CT can identify patients with retropharyngeal infections who have a high likelihood of being successfully treated with antibiotics alone.

SIGNIFICANCE: CT imaging may assist in avoiding unnecessary surgical exploration.