Ann Rehabil Med.  2012 Aug;36(4):565-568. 10.5535/arm.2012.36.4.565.

Retropharyngeal Abscess Initially Diagnosed by the Videofluoroscopic Swallowing Study

• Leigh JH
• Jung SH

• KMID: 2266730
• DOI: http://doi.org/10.5535/arm.2012.36.4.565

Abstract

In this article, we report a case where a videofluoroscopic swallowing study (VFSS) revealed the cause of a recently developed idiopathic dysphagia in a 66-year-old patient and enabled emergent treatment. The patient reported a 10-day history of fever, cough, sputum production, and progressive jaundice. He was then admitted to the hospital with suspicion of aspiration pneumonia. Despite treatment with antibiotics, fever and leukocytosis were persistent. As he also reported dysphagia, we performed the VFSS, which showed subglottic aspiration on all types of food and revealed a retropharyngeal mass causing mechanical compression. A contrast-enhanced computerized tomography (CT) of his neck was performed following the VFSS, which helped diagnose the mass as an extensive retropharyngeal abscess with mediastinitis. Following this diagnosis, emergent surgical incision and drainage was performed on the patient. Although the VFSS is primarily designed to evaluate swallowing function rather than to diagnose a disease, it can be used to reveal the primary medical cause of dysphagia while it studies the mechanical and structural abnormalities in the oropharyngeal and esophageal regions. This study also proposes that retropharyngeal abscess should be considered in the differential diagnosis of cases showing progressive dysphagia with fever. As confirmed through this work, the VFSS can function as a useful tool for detecting crucial diseases accompanying deglutition disorder.

Keyword

Retropharyngeal abscess; Deglutition disorders; Fluoroscopy

MeSH Terms

Aged
Anti-Bacterial Agents
Cough
Deglutition
Deglutition Disorders
Diagnosis, Differential
Drainage
Fever
Fluoroscopy
Humans
Jaundice
Leukocytosis
Mediastinitis
Neck
Pneumonia, Aspiration
Retropharyngeal Abscess
Sputum
Anti-Bacterial Agents

Figure

• 

  Fig. 1 Still image of the first VFSS. Retropharyngeal soft tissue was severely swollen (arrow) with a shifting airway (arrowhead) anteriorly.

• 

  Fig. 2 Contrast-enhanced CT scan of the neck. Retropharyngeal abscess (arrowhead) was extended from upper pharynx (A) to the upper mediastinum (B).

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  Fig. 3 Still image of the second VFSS. The thickness of the retropharyngeal soft tissue is normal (arrow).

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