CT-based diagnosis in patients presenting with throat pain: A single institutional review.

RATIONALE AND OBJECTIVE: To determine if patient demographic data, medical history, physical examination, and laboratory tests will help predict likelihood of imaging-based diagnosis using CT of the neck performed in the ED for a chief complaint of throat pain. MATERIAL AND METHODS: Single institutional, retrospective review of 367 CT scans of the neck performed for the evaluation of throat pain in the ED from August 2013 to September 2019. Patients' clinical history, physical exams, lab findings, and imaging results were recorded. RESULTS: A total of 367 CT scans of the neck performed for the evaluation of throat pain included a recorded exam and clinical history. Of these cases, we noted that the presence of cervical lymphadenopathy (OR = 2.69; 95% CI, 1.37-5.49), tonsillar findings (OR = 2.94; 95% CI, 1.4-6.57), increased white blood cell count (OR = 1.08; 95% CI, 1.02-1.15), and temperature (OR = 1.94; 95% CI, 1.1-3.6) were associated with increased likelihood of obtaining a diagnostic CT scan. CONCLUSION: Consideration of tonsillar abnormalities, lymphadenopathy, body temperature, and measured leukocyte count prior to ordering CT scans of the neck for throat pain may increase the diagnostic yield of such exams and decrease CT utilization in the ED.

Something's "Fishy" With That Sore Throat...

A 9-year old male presented to the emergency department for the evaluation of a sore throat. Initial history of present illness stated in the triage note was that "the child complained of a sore throat," suggesting possible pharyngitis. There was no evidence of stridor, sialorrhea, hypoxia, or aphonia. Further investigation of the history of present illness identified the concern for a possible esophageal foreign body. Imaging studies of the neck identified a fishbone in the esophagus. This case presentation discusses an atypical presentation of an esophageal foreign body and the subtle findings on assessment and imaging. This case highlights the importance of illiciting a history of present illness and the subtleties of esophageal foreign body identification.

COVID-19 in cancer patients can be challenging to screen in a resource limited setting.

During this COVID-19 pandemic, patients with symptoms such as fever, cough, sore throat, and coryza were advised to have RT-PCR testing for SARS-CoV-2 infection. We described here an elderly female with chronic lymphocytic leukemia, who presented with atypical symptoms that were not directly attributable to COVID-19. This patient was admitted to the non-COVID-19 ward for supportive care. Later, her chest x-ray revealed pneumonia that was confirmed to be COVID-19 by RT-PCR testing several days later. In resource-poor settings where molecular testing results suffered from delays or were altogether unavailable, the use of diagnostic imaging such as a chest x-ray could serve as a quick guide in the assessment and management of these patients especially if the imaging results suggest COVID-19 infection.

Non-traumatic causes of fluid in the retropharyngeal space.

There are multiple reasons for imaging the soft tissues of the neck in the emergency setting, in particular when symptoms are vague or if there is worry for complications from a certain clinical diagnosis. When fluid is seen in the retropharyngeal space, it is important to pay attention to history and look at key structures in the neck. This article will discuss anatomy of the retropharyngeal space, followed by four causes of fluid within the space that the radiologist is likely to encounter in the emergency setting: tonsillitis/pharyngitis, acute calcific tendinitis of the longus colli muscles, internal jugular vein thrombosis, and post-radiation changes. It is important to recognize these entities because each has different clinical implications and management.

Bilateral vocal cord immobility resulting from cytomegalovirus pharyngitis: A case report.

Human cytomegalovirus (CMV) is an infectious herpes virus present in approximately 50% of the world's population. Pharyngitis is an uncommon manifestation of CMV infection, and vocal cord immobility (VCI) following CMV pharyngitis is quite rare. An 83-year-old man with well-controlled diabetes mellitus and hypertension was admitted due to dyspnea, odynophagia, and dysphagia. Laryngeal fiberscopy revealed bilateral vocal cords almost fixed at the median position, with mucosal redness, swelling, and edema at the hypopharyngeal area. The airway was so narrowed that an emergency tracheostomy was performed to secure an airway. VCI resulting from a malignant tumor was suspected at first, but repeated pathological examinations revealed CMV infection in the pharyngeal mucosa. Despite intravenous ganciclovir treatment (5 mg/kg), the patient's bilateral VCI improved only slightly. Laryngeal electromyography was used to investigate the causes of VCI, and revealed vocal fold paralysis on the left side and cricoarytenoid joint fixation on the right side. This case highlights the importance of considering CMV infection in the differential diagnosis of patients with pharyngitis and VCI. To the best of our knowledge, this is the first case report describing the etiology of VCI following CMV pharyngitis using laryngeal electromyography.

Pharyngeal tuberculosis: Report of 5 cases. / Tuberculosis faríngea: 5 casos clínicos.

Tuberculosis is a public health problem for many countries, whether rich or poor. Extranodal ENT locations are rare, and it prevails in the cavum in the pharyngeal region. Based on a 3-year retrospective study of 5 clinical cases, the authors aim to highlight the epidemiological, clinical, radiological, therapeutic and prognostic aspects of this disease. Clinical aspects are not specific and there is often confusion in the differential diagnosis with tumoral lesions. Positive diagnosis is guided by the clinical and the radiological findings, and confirmed by histology.

Eosinophilic disorders of the gastrointestinal tract: imaging features.

Eosinophilic disorders of the gastrointestinal tract are increasingly rare but remain an important cause of long-standing gastrointestinal symptoms. Diagnosis is usually delayed because the disease mimics other inflammatory disorders and is often not suspected initially. We report a series of four cases to highlight the various imaging appearances of this condition. Two patients presented with upper gastrointestinal involvement, one patient presented with small and large bowel involvement, and one patient presented with diffuse involvement of the entire gastrointestinal tract.

[Jugular vein thrombosis and Lemierre's syndrome--severe complications of oropharyngeal infections]. / Jugularvenenthrombose und Lemierre-Syndrom--schwerwiegende Komplikationen oropharyngealer Infekte.

BACKGROUND: Acute oral or pharyngeal infections usually heal under adequate therapy within a few days. Therefore severe regionary or systemic complications are not regularly seen. PATIENTS AND METHODS: We report on 3 patients in whom during or after apparent recovery from a pharyngeal or perioral infection a one-sided painful swelling of the neck associated with fever and leucocytosis developed. RESULTS: Color Doppler sonography (CDS) revealed unilateral thrombosis of the internal jugular vein (IJV) in all cases, whereupon we initiated high-dosed parenteral antibiotic therapy and therapeutic heparinisation. Furthermore, we drained detectable abscess formations. Nonetheless, in one patient fever attacks occurred postoperatively, accompanied by septic-embolic lung infiltrates, corresponding to Lemierre's syndrome. In all cases, we achieved clinical recovery and remission of infection. The course was significantly prolonged in the patient with pulmonary involvement and in this patient no reperfusion of the IJV was achieved. CONCLUSIONS: Even today serious complications may occur unexpectedly in presumed everyday oral or pharyngeal infections. CDS is a suitable procedure to disclose a jugular vein thrombosis (JVT) promptly and non-invasively. Parenteral antibiotic therapy for at least 10 days is usually the therapy of choice for JVT; additional full-heparinisation is controversially discussed in the professional literature. Septic pulmonary embolism following pharyngeal infection and JVT, as described by Lemierre, was associated with a high rate of mortality in the pre-antibiotic era, and even today may be fatal in spite of appropriate and maximal therapy.

The patient with sore throat.

Sore throat is a common medical complaint seen by the emergency practitioner, internist, pediatrician, and otolaryngologist. The differential for sore throat is vast. However, with a directed history this can often be narrowed down to 2 to 3 possible diagnoses. By paying particular attention to the associated symptoms and duration of symptoms, common self-limited etiologies like viral pharyngitis and nonstreptococcal tonsillitis can be distinguished from those that require more investigation, such as supraglottitis and tonsillar cancer. A sore throat is most commonly caused by an infectious, inflammatory, or neoplastic etiologic factor.

Citrobacter freundii causing pharyngitis and secondary retropharyngeal abscess with intrathoracic extension to the diaphragm: minimally invasive management of a rare case.

INTRODUCTION: Citrobacter freundii is a rare but potentially aggressive cause of pharyngitis which may progress to retropharyngeal abscess with diaphragmatic extension. OBJECTIVE: To raise awareness of: (1) citrobacter as a potential cause of head and neck infection, including retropharyngeal abscess; (2) a novel surgical approach to draining such an abscess; and (3) citrobacter's particular biological properties which may affect the clinical course. METHOD: Case report. RESULTS: The abscess was drained via a minimally invasive posterior pharyngeal wall incision and placement of a suction catheter into the mediastinum through this incision. Residual intrathoracic collections were drained by the cardiothoracic team via percutaneous aspiration. The patient made a full recovery. CONCLUSION: Early recognition of citrobacter head and neck infections, an awareness of the peculiarities of the clinical course of such infections, and timely surgical intervention can prevent catastrophic outcomes. A minimally invasive approach to mediastinal collections can be considered as a viable alternative to open thoracotomy, which carries a high morbidity rate.

Pharyngitis of infectious mononucleosis: computed tomography findings.

Two women presented with sore throat and fever. Their symptoms were not alleviated by antibiotics. Cervical computed tomography (CT) with contrast enhancement demonstrated enlargement of predominant posterior cervical lymph nodes and streaky heterogeneous tonsils with interspersed low attenuation. They were diagnosed as having infectious mononucleosis by their laboratory data. Thus, when radiologists encounter these CT findings of pharyngitis that is not alleviated by antibiotic therapy, infectious mononucleosis should be considered in the differential diagnosis.

Lemierre's syndrome: Porphyromonas asaccharolytica as a putative pathogen.

A case of Lemierre's syndrome is reported in which metastatic abscesses resulted from septic thrombophlebitis of the internal jugular vein secondary to bacterial pharyngitis. A 32-year-old male suffering from a painful left-sided neck mass, sore throat, and fever was admitted to our hospital. Computed tomography revealed thrombosis of the left internal jugular vein, septic pulmonary emboli, and a liver abscess. Blood culture showed Porphyromonas asaccharolytica. Although empyema occurred transiently during the treatment, the patient recovered following prolonged antimicrobial therapy. Although Fusobacterium species are a well-known cause of Lemierre's syndrome, cases in whom Porphyromonas species was isolated have scarcely been reported. Moreover, case reports from Japan have been few.

Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management.

OBJECTIVE: We sought to describe the clinical presentation of patients with retropharyngeal abscess (RPA), utility of imaging studies, and implications on management. METHODS: A retrospective chart review was performed at a tertiary-care, pediatric hospital with cases identified by a discharge diagnosis of RPA; posttraumatic RPA cases were excluded. Patients without confirmatory radiographic findings, fluoroscopy, or computed tomography (CT) were excluded. RESULTS: Sixty-four cases involving 64 patients were studied. The median age of the patients was 36 months; 48 (75%) of the 64 patients were younger than 5 years. The most common chief complaints were neck pain (38%), fever (17%), sore throat (17%), neck mass (16%), and respiratory distress or stridor (5%). In 29 children (45%), it was noted that there was limitation of neck extension, in 23 (36.5%) torticollis, and in 8 (12.5%) limitation of neck flexion. The physical examination revealed stridor with wheezing in only 1 patient (1.5%) and wheezing in 1 other (1.5%). Twenty-seven patients (42%) underwent surgery; 37 (58%) were treated with antibiotics only. Performance of a surgical procedure was significantly associated with CT scan findings. Ten (37%) of 27 patients with defined abscess on CT scan were treated with antibiotics alone. There were no treatment failures in either the antibiotic-only group or the antibiotics-plus-surgery group. CONCLUSIONS: Children with RPA present with limitation of neck movement, especially difficulty extending their neck to look up. They rarely present with respiratory distress or stridor. CT scan is useful to distinguish patients with RPA from those with retropharyngeal cellulitis. Most patients with retropharyngeal cellulitis and some with RPA can be treated successfully without surgery.

[Deep infections of the neck]. / Infecciones profundas del cuello.

Infections of aponeurotic sheets of the neck are more frequent in men than in women. Its etiology although varied is basically related to infectious pharyngo-tonsillar and dental pathology. In a great deal of cases there are factors which predispose clinical manifestations or becoming complications. Early diagnosis and precocious specific treatment re-establish the normality in the majority of cases but a percentage of them resort to surgery for the condition's control.

Mesenteric lymphadenitis depicted by indium 111-labeled white blood cell imaging.

An acutely ill child with abdominal pain and concomitant pharyngitis often presents a diagnostic challenge. This report describes how indium 111-labeled white blood cell imaging helped to clarify the confusing case of a 4-year-old boy with fever, pharyngitis, and abdominal pain. The triad of abnormal white cell localization in the nasopharynx, cervical lymph nodes, and right lower abdominal quadrant supported the diagnosis of a systemic infection rather than appendicitis, abscess, or another surgical condition. Mesenteric lymphadenitis associated with systemic infection should be included in the differential diagnosis of abdominal pain in a child with this clinical presentation.

[Postanginal sepsis caused by Fusobacterium necrophorum: Lemierre syndrome]. / Postangineuze sepsis door Fusobacterium necrophorum: het syndroom van Lemierre.

Postanginal sepsis or Lemierre's syndrome is characterised by septic thrombophlebitis of the jugular vein, metastatic abscesses in the lungs, soft tissues, joints or elsewhere, occurring several days to two weeks after tonsillitis or pharyngitis. The primary pathogen is a Gram-negative anaerobic rod, mostly Fusobacterium necrophorum. Previously healthy, young adults are affected mainly and the syndrome was seen more frequently in the pre-antibiotic era than it is nowadays. In the three young patients described here, a girl aged 15 and two boys aged 18 and 16, F. necrophorum was isolated from blood or pus. Histories and examinations were suggestive of Lemierre's syndrome. Ultrasound and CT scanning of the neck and other localisations proved to be important diagnostic tools in assessing the diagnosis. Response to therapy was slow and depended in at least one case on adequate drainage of abscesses. If the syndrome is suspected, initial antibiotic treatment should provide adequate coverage of anaerobic bacteria. In previously healthy patients with chills and fever occurring several days after a sore throat, Lemierre's syndrome should be considered.