Hot Seat Denouement #231

Posted on: June 27, 2024, by :

This week’s case involved a child who initially presented with presumed bronchiolitis but developed worsening neck swelling and respiratory distress.

As the neck swelling and respiratory distress intensified, discussions focused on the next steps for escalating respiratory support and imaging. The team had to consider whether the patient could remain stable while lying flat for imaging given the expanding neck swelling. Given the concern for an expanding neck mass and a compromised airway, intubation became a priority.

Anesthesia was called to intubate due to the concern for a difficult airway. A CT scan revealed the presence of a retropharyngeal abscess (RPA) versus phlegmon. The child was admitted to the PICU, where ENT specialists ultimately performed an I&D. Antibiotics were initiated. Cultures grew group A streptococcus, and the patient also tested positive for RSV.

This case underscores the importance of frequent reassessments and revisiting the differential diagnosis when the clinical course deviates from the expected. It highlights the need for a high index of suspicion and adaptability in managing complex pediatric cases.

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