A young man presents with a severe sore throat. He was here yesterday and received antibiotics. Today he feels worse. You look in the throat expecting a peritonsillar abscess but the throat looks completely normal, not even erythema.
Amidst the busy emergency department practice, sometimes we need a reason to take a second, closer look. Always trust your gut. In this case the patient had severe pain but no erythema. The concerning finding was not the severe sore throat or the normal examination, but the incongruity of both. Is there something deeper going on? What else should you check?
Check range of motion. He can do it but has severe pain, not so much with flexion but definitely with extension. You order a CT scan and it shows a retropharyngeal abscess.
I would have hoped to a review of the physical findings on this condition but they appear to be very limited (odynophagia, trismus, stridor, muffled voice)
Take Home Points:
-Incongruity/anomalous findings get your attention
-Check range of motion for suspected deep space infection of the neck