Deep Space Infection of the Neck? Check Range of Motion

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.

 

Now what?

 

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

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s