A previously healthy 12-month-old girl had a 3-day history of fever (temperature, 40°C), sore throat, dysphagia, and vomiting. Physical examination revealed 2 3-cm left cervical adenopathy and hepatosplenomegaly. No focal infection was identified.
Admission chest roentgenogram was normal. White blood cell count was 12.5 × 109/L (0.52 neutrophils); Creactive protein level was elevated (294 mg/L). Cerebrospinal fluid and urinalysis findings were normal. Three blood cultures yielded Staphylococcus aureus, methicillin sodiumsusceptible.
Despite antibiotic treatment with vancomycin hydrochloride, rifampin, and amikacin sulfate, she remained febrile with positive blood cultures for days. There was no dyspnea or dysphagia. On the third day after admission, a chest roentgenogram was abnormal (Fig 1). A left posterior oblique chest roentgenogram (Fig 2) and lateral neck roentgenogram (Fig 3) with barium swallow were obtained.
Denouement and Discussion
Extrapleural Effusion of Retropharyngeal Origin
The diagnosis of cervicoextrapleural and cervicomediastinal extension of a retropharyngeal abscess was suspected. With the patient under general anesthesia