Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall

Abstract

Rationale: Tuberculous retropharyngeal abscess is rare, but it can be fatal if not treated appropriately. It usually occurs secondary to tuberculosis of the cervical spine. Moreover, tuberculous abscess involving the chest wall is relatively rare in skeletal tuberculosis. Although the optimal treatment is controversial, most clinicians suggest a combination of sufficient antituberculous medication and complete resection to prevent recurrence and increase therapeutic efficacy. Herein, we present an unusual case of retropharyngeal abscess with cervical Pott disease and tuberculous abscess of the chest wall. Patient concerns: The patient was a 27-year-old Indonesian woman who had neck pain, dysphagia, and odynophagia, but no neurological deficit. Examination of the oral cavity showed anterior displacement of the posterior pharyngeal wall. The mass over the right anterior chest wall measured approximately 5 × 4 cm in size. Diagnoses: Radiography and computed tomography findings were suggestive of retropharyngeal abscess extending to the cervical spine and chest wall abscess. Interventions: She was admitted to the hospital for treatment. Drainage of the retropharyngeal and chest wall abscesses with debridement of the chest wall was performed. Outcomes: No complications occurred after early surgical treatment and administration of antituberculous medication. The patient recovered well and went back to her own country after discharge. Lessons: Tuberculous retropharyngeal abscess with Pott disease and tuberculous abscess of the chest wall are both complicated diagnoses that physicians have to consider in similar patient presentations.

Tuberculous retropharyngeal abscess presenting as severe dyspnea

“…Dysphagia, dysphonia, dyspnea, neck pain, torticollis, and spinal deformities can reveal the disease. 2,7,8 Our patient was referred for severe dyspnea. Insidious to severe neurological deficit can be found, due to inflammatory irritation or cervico-medullary compression.…”

“…3,4,6 However, airway obstructive retropharyngeal abscess is an exceptional and potentially life-threatening condition. [1][2][3] The clinical picture is nonspecific. Dysphagia, dysphonia, dyspnea, neck pain, torticollis, and spinal deformities can reveal the disease.…”

“…5,6,9 Tuberculosis infectious symptoms, as night fever or sweats, asthenia and weight loss, are not always present. 2,5,7,8,10 Lateral X-rays of the cervical spine can be a useful diagnostic tool by showing vertebral destruction. 2,8,10 CT scan demonstrates retropharyngeal abscess, destructive bone lesions of cervical vertebrae and disc involvement.…”

“…2,5,7,8,10 Lateral X-rays of the cervical spine can be a useful diagnostic tool by showing vertebral destruction. 2,8,10 CT scan demonstrates retropharyngeal abscess, destructive bone lesions of cervical vertebrae and disc involvement. 5,7,9 CT scan also precise spinal statics.…”

“…1 The symptomatology is non-specific, and diagnosis remains difficult. 2 When misdiagnosed, it can lead to neurological or life-threatening complications. 2,3 The authors report a new case of airway obstructive retropharyngeal abscess revealing cervical Pott disease.…”