PP 72 ‘DEADLY STRIDOR’ RETROPHARYNGEAL ABSCESS IN AN ELDERLY PATIENT

Abstract

INTRODUCTION

Retropharyngeal abscess is rare in adults. We present such case in an elderly gentleman presenting to our centre.

CASE DESCRIPTION

A 66 years old Chinese man with the background history of hypertension had a procedure under general anaesthesia for open biopsy of a granulomatous lesion on his right posterior lumbar area 2 weeks earlier. He presented to our centre with the chief complaint of hoarseness of voice for 2 weeks developing after the procedure associated with difficult and noisy breathing. There was also a productive cough with white sputum. Upon arrival, patient had stridor and triaged to the red zone. His vital signs showed BP 162/88, PR 124, T 37.9 and SPO2 100%. On examination, patient was alert, conscious, tachypnoeic and loud inspiratory stridor was heard. There was no salivation at all. Throat inspection was normal. Generalized ronchi with tight air entry heard over both lungs. Initially a working diagnosis of bronchospasm secondary to hospital acquired pneumonia was made. A differential of epiglottitis and anaphylaxis were thought for. Patient was put on high flow mask at 15 L/min. Nebulizer using salbutamol and adrenaline were given. IV dexamethasone 8mg was started. IV Rocephine 2g administered as antibiotics. Subsequently, lateral neck X-ray showed expanded diameter of C6 and C7 retropharyngeal space while the anterior neck X-ray showed the ‘steeple’ sign. A final diagnosis of retropharyngeal abscess complicated by laryngeal oedema and sepsis was made. Patient was referred immediately to the ENT team as well as the anasthesiology team. He was then sent to the general operation theatre for elective intubation upon which laryngeal oedema was confirmed and admitted to the ICU. Unfortunately, patient deteriorated in the ICU and succumbed to death after 5 days there. 

DISCUSSION & CONCLUSION

Retropharyngeal abscess is rare in adults. Have high index of suspicion for patients developing stridor after an invasive procedure. Early presentation to hospital and administration of antibiotics could have saved the patient’s life.