Branchial-Cleft Sinus Presenting with a Retropharyngeal Abscess for a Newborn: A Case Report

ABSTRACT

A retropharyngeal abscess rarely occurs in the neonate. We report a neonate without apparent trauma who presented with a left neck mass and respiratory distress at the fourth day of age. A lateral neck X-ray revealed a widened retropharyngeal space. A neck computed tomography (CT) scan revealed a space-occupying lesion with air content in the left retropharyngeal area, although direct laryngoscopy, endoscopy, and a pharyngoesophagogram did not demonstrate the presence of any fistula tract. Due to the high index of suspicion for an aero-digestive tract fistula, diluted contrast medium was injected into the cyst while performing a CT-guided aspiration, and opacification was found in the oropharynx, thus a branchial-cleft sinus appeared to be most likely. The follow-up neck CT scan revealed no evidence of any recurrence. We suggest that CT-guided aspiration and cystography are useful for the diagnosis and treatment of some neonatal neck cystic lesions.

KEYWORDS

Retropharyngeal abscess - neonate - branchial-cleft sinus - computed tomographic scan

REFERENCES

• 1 Coulthard M, Isaacs D. Neonatal retropharyngeal abscess.  Pediatr Infect Dis J . 1991;  10 547-549
• 2 Coulthard M, Isaacs D. Retropharyngeal abscess.  Arch Dis Child . 1991;  66 1227-1230
• 3 Morrison Jr E J, Pashley N R. Retropharyngeal abscesses in children: a 10-year review.  Pediatr Emerg Care . 1988;  4 9-11
• 4 Gaglani M J, Moise A A, Demmler G J. Neonatal radiology casebook. Retropharyngeal abscess in the neonate.  J Perinatol . 1996;  16 231-233
• 5 Jones S W, King J M. Retropharyngeal abscess secondary to nasopharyngeal CPAP in a preterm neonate [letter].  Arch Dis Child . 1993;  68 620
• 6 Gudinchet F, Chapuis L, Berger D. Diagnosis of anterior cervical spinal epidural abscess by US and MRI in a newborn.  Pediatr Radiol . 1991;  21 515-517
• 7 Asmar B I. Neonatal retropharyngeal cellulitis due to group B streptococcus.  Clin Pediatr . 1987;  26 183-185
• 8 Smith W L, Yousefzadeh D K, Yiu-Chiu V S, Franken E A. Percutaneous aspiration of retropharyngeal space in neonates.  Am J Roentgenol . 1982;  139 1005-1006
• 9 Mahomed A, Youngson G. Congenital lateral cervical cysts of infancy.  J Pediatr Surg . 1998;  33 1413-1415
• 10 Mouri N, Muraji T, Nishijima E, Tsugawa C. Reappraisal of lateral cervical cysts in neonates: pyriform sinus cysts as an anatomy-based nomenclature.  J Pediatr Surg . 1998;  33 1141-1144
• 11 Sharma H S, Razif A, Hamzah M. et al . Fourth branchial pouch cyst: an unusual cause of neonatal stridor.  Int J Pediatr Otorhinolaryngol . 1996;  38 155-161
• 12 Edmonds J L, Girod D A, Woodroof J M, Bruegger D E. Third branchial anomalies: avoiding recurrences.  Arch Otolaryngol Head Neck Surg . 1997;  123 438-441
• 13 Reiter D. Third branchial cleft sinus: an unusual cause of neck abscess.  Int J Pediatr Otorhinolaryngol . 1982;  4 181-186
• 14 Lee F P. Occult congenital pyriform sinus fistula causing recurrent left lower neck abscess.  Head Neck . 1999;  21 671-676
• 15 Marsot-Dupuch K, Levret N, Pharaboz C. et al . Congenital neck masses-embryonic origin and diagnosis: report of the CIREOL [in French].  J Radiol . 1995;  76 405-415
• 16 Glasier C M, Stark J E, Jacobs R F. et al . CT and ultrasound imaging of retropharyngeal abscesses in children.  Am J Neuroradiol . 1992;  13 1191-1195