W. Weiwad (Halle)  

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6 Years  

Male  

Neck-Muscular system / Connective tissue / Skin  

inflammatory or infectious  

6 year old boy sledded into a thorn bush on 23.12.01 with an open mouth. In the course of an out-patient ENT-consultation, a wood splinter was removed from the right tonsil. On the 28th of December, the boy presented painful torticollis and fever which gave rise to the question of a neck abscess.

After completing the MRI (Image 1 & 2), an abscess tonsillectomy with drainage of large amounts of pus from the parapharyngeal space was performed. During the surgical inspection, the foreign object that was suspected in the radiological findings was not seen.

In the postoperative CT (29th December), the MRI findings of a foreign object with surrounding abscess was supported. In the following operation, the foreign object was confirmed.  

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MRI 1 und

<- view MRI 2

MRI 2: MRI dated from December 28: Taking the age of our patient in consideration, a diagnostic MRI without sedation was performed. Some movement artefacts were taken into account. Head-positioning was done diagonally due to painful movement of the head.
The MRI shows an almost 3 cm foreign body, which is low in signals. This reaches from the dorsal part of the right tonsil through the parapharyngeal space along the large neck vessels almost up to the hind edge of the sternocleidomastoid muscle. Surrounding this finding is an obvious inflammatory response with inclusion of the soft palate, pharyngeal wall, parapharyngeal space and dorsal neck triangle. Caudally, this reaches to about the level of the glottis. After contrast application, an area of demarcation around the foreign body is seen, with limited enhancement of the edges. Furthermore, ipsilateral swelling of the lymph nodes can be seen.








<- view CT 1

CT 1: CT dated January 29, 2001 (Image 3): After tonsillectomy, the findings of the right parapharyngeal space is basically unchanged. However, the suspicion of foreign body is now stronger.





 

Surgery / Histo  

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Parapharyngeal, Abscess, Staking, Injury, child, childhood, pediatric radiology  

W Weiwad. Parapharyngeal Abscess after Staking Injury. PedRad [serial online] vol 2, no. 3.
URL: www.PedRad.info/?search=20020319155209