A Difficult Differential Diagnosis in New Neck Masses: Retropharyngeal Abscess or Malignancy?

Division

South Atlantic

Hospital

Grand Strand Medical Center

Document Type

Case Report

Publication Date

6-7-2024

Keywords

antibiotic treatment, delayed diagnosis, drug susceptibility testing and antibiotic resistance, emergent airway, guidelines in medicine, oral maxillofacial radiology, partial airway obstruction, radiology & imaging, retropharyngeal abscesses

Disciplines

Bacterial Infections and Mycoses | Internal Medicine | Medicine and Health Sciences | Neoplasms

Abstract

Retropharyngeal abscesses (RPAs) are rare in the adult population and rarer without an inciting event or comorbidity such as recent oral surgery, neck infection, or pharyngeal trauma. The definitive treatment is incision and drainage of the abscess. Clinical researchers have recently questioned whether invasive surgical intervention is necessary and posed the question of what role antibiotics play in management. Sequelae of RPAs are severe and include rupture of the abscess, erosion of the carotid artery, thrombophlebitis, and most seriously, airway compromise. We present a case where an atypical presentation of an RPA caused a disagreement among specialists, and the debate of whether the described case represented an abscess or malignancy caused a delay in diagnosis and treatment for the patient. Only after invasive and emergent surgical intervention was a final diagnosis able to be made. This case demonstrates the need for more research and official guidance on the management of new neck masses to hasten diagnosis and prevent devastating outcomes.

Publisher or Conference

Cureus

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