Friday Quiz # 26 - How would you confirm this diagnosis? | Figure 1

CincyKidsRad
Cincinnati Children's Radiology

Friday Quiz # 26 - How would you confirm this diagnosis?

Lateral radiograph of the airway (image 1) in an infant with stridor shows bulging and enlargement of the retropharyngeal soft tissue concerning for a retropharyngeal space abscess.

How would you confirm this diagnosis?

The author made an update to this case

Update 1

Diagnosis can be found by visiting the post entitled "Friday Quiz # 26 Answer"

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59 y/o male with 10 days of sore throat and progressive dysphagia. Hemodynamic stable. WBC 17,1. TC with large retropharyngeal absecess that extends to posterior mediastinum. Surgical drainage through a cervical incision and mediastinoscopy.

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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.

A man in his thirties sustained a seizure after swallowing a considerable amount of cocaine (3.5 g est.), goes to develop a respiratory arrest then cardiac arrest. (Well, as he was chased by the police)
Out of hospital CPR, Intubated and ventilated on scene
Downtime time before arrival to ED is 45 min. No ROSC.
In ED: ROSC
A/B: intubated with good air entry and no signs of PTX, SaO2: poor trace
C: HR 70, very wide QRS almost like sine wave, BP 130/70, good radial
D: chewing on the tube only with fixed and dilated pupils
ABG (units in kPA) pH 6.6 PO2 20 BE-30 Lactate unrecordable high K 6.14
ECHO: good cardiac activity with no effusion or big clots
Two IV access with 0.9% sodium chloride running
Temp 34.8
Then,
He develops a tachyarrhythmia, had a seizure for seconds --> flat line / PEA. CPR Commenced with one adrenaline IV given for two minutes. ROSC in 2 minutes.
C: HR 70, very wide QRS BP 110/78
D: fixed and dilated pupils
You are the lead of this Resus case.
How would you proceed?
What treatment could you give?
Would you call it a day?
Please let me hear your thoughts.