Point of Care Ultrasound (POCUS) Diagnosis of Deep Neck Space Abscess: A Case Series

Background

Para and Retropharyngeal abscesses are deep neck infections of early childhood that can be complicated by serious sequelae such as airway obstruction, cervical necrotizing fasciitis, mediastinitis, aspiration pneumonia, jugular thrombosis or aneurysm of the carotid artery. Traditionally, these infections were diagnosed with computed tomography (CT) of the neck, which exposes sensitive structures to radiation and may require sedation.

Case Report

We present a case series of four children diagnosed using point of care ultrasound (POCUS) with para or retropharyngeal abscess later confirmed on CT. All four had alternative working diagnoses on pediatric emergency physician or otolaryngology physical examination prior to investigation with POCUS. We also describe a novel imaging approach that allows for easier identification of deep neck anatomic landmarks.

Why Should an Emergency Physician Be Aware of This?'

Pediatric emergency physicians should be skilled in imaging the deep neck spaces in order to avoid delayed diagnosis of deep neck space abscess and its potentially catastrophic sequelae.