Correlation between computed tomography and surgical findings in retropharyngeal inflammatory processes in children

Retropharyngeal abscess (RPA) in children is a potentially life-threatening process which often requires immediate surgical intervention. Contrast enh anced computed tomography (CT) is utilized frequently to determine abscess versus cellulitis/phlegmon and aids in determining cases needing surgical d rainage. The purpose of this retrospective study was to determine the accur acy of CT in distinguishing retropharyngeal abscess from cellulitis in chil dren. The medical records of 32 children from 1989 to 1997 suspected of hav ing a retropharyngeal abscess were reviewed. All patients included in the s tudy underwent a CT scan as well as surgical exploration within 48 h of the scan. Two patients required two surgical procedures (n = 34). A comparison between CT results and operative findings was made to determine the accura cy of CT imaging in confirming the presence of RPA versus cellulitis. Suspe cted diagnosis of abscess or cellulitis/phlegmon on CT was confirmed at sur gery in 25 of 34 cases (73.5%). The false positive rate of CT scan was 11.8 % (4/34), while the false negative rate was 14.7% (5/34). Based on our resu lts, CT is accurate in differentiating abscess from cellulitis in 73.5% of cases. Clinical findings, as well as radiologic findings, must be considere d together prior to surgical drainage of a suspected retropharyngeal absces s in children. (C) 1999 Published by Elsevier Science Ireland Ltd. All righ ts reserved.