2 week strep throat progression | Figure 1

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2 week strep throat progression

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16 year old female, with sore throat, low grade fever, ear pain, jaw pain with limited ROM. Normal white count, negative strep. The papilla seen in the image (just behind the palatoglossal arch) was present bilaterally, not tender when touched with swab and had a yellowish tinge at the distal tip.


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Image description
Lateral radiograph of the airway (image 1) shows widening of the retropharyngeal soft tissues with narrowing of the upper airway. Soft tissue stranding is present in the submandibular space. Axial contrast-enhanced CT (images 2 and 3) shows a retropharyngeal fluid collection (arrow) with faint rim enhancement (arrowhead).

Teaching point
On lateral neck radiographs, abnormal widening of the retropharyngeal soft tissues and airway narrowing raise concern for deep neck space infection. CT can help to distinguish an abscess from phlegmon. Key distinguishing features include air within a collection or nearby soft tissues or a low-attenuation collection with peripheral enhancement.


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