E. U. SAZ, G. ERDEMİR, S. ÖZEN, S. AYDOĞDU

Clinical dilemma on retropharyngeal cellulitis and croup

Bu olgu, laringotrakeit klinik belirtilerini birebir taklit edip yanılsamalara neden olan retrofaringeal yumuşak doku enfeksiyonlarının ciddiyetini vurgulamak amacıyla sunulmuştur. Olgu acil servise stridor ve hırıltılı solunum yakınmaları ile getirildi. Fizik bakısında alt, üst interkostal retraksiyonları saptanan ve burun kanadı solunumu olması nedeni ile ilk planda krup sendromu olarak düşünülen bir olguydu. Krupa yönelik olarak uygulanan tedavilere yanıtsız ve kliniğin daha da ağırlaşması üzerine çekilen lateral servikal grafi ve boyun tomografisinde retrofaringeal genişleme saptandı. Kulak burun boğaz kliniği operasyon odasında direkt laringoskopi ile drenaj uygulandı. Olgudaki enfeksiyonun retrofaringeal sellülit ile uyumlu olduğu düşünülerek metronidazol ve seftriakson tedavileri başlandı ve şifa ile taburcu edildi.

Retrofaringeal yumuşak doku enfeksiyonları ile krup arasındaki klinik ikilem

We report a case of retropharyngeal cellulitis which exactly mimics the croup symptoms. The case reported was an 19-month-old male. He was brought to the emergency department with a chief complaint of stridor and his mother denied any fever, trauma, upper respiratory or gastrointestinal complaints. He was alert, drooling, and became agitated when approached. He was intermittently stridulous, especially when placed supine, although he was not hoarse at rest. His neck was not hyperextended in the “sniffing” position . He had moderate substernal, intercostal, and supraclavicular retractions an nasal flaring. In addition, mild expiratory wheezing was appreciated upon auscultation. Examination of the neck revealed some anterior and posterior lymphadenopathy. Both lateral neck radiograph and computed axial tomograpy revealed that the present case has retropharyngeal widening and possible abscess. Based on these findings direct larygoscopy and aspiration was performed and diagnosed as cellulitis. Since the symptoms have improved with intravenous metronidazol and ceftriaxone he was discharged from the hospital.

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