You are seeing a 2 year old boy with a high fever who is irritable and refuses to look up. His parents think he has a sore throat. You are appropriately worried about a retropharyngeal cellulitis/abscess and obtain the following X-Ray.
Fortunately he is adequately protecting his airway. What if he wasn’t? How would you know? Keep in mind that a child with an impending airway disaster will maintain a position of comfort even if they have stridor (really bad croup), or drooling (epiglottitis). Patients with any of the following signs/symptoms deserve a detailed workup including labs (CBC and blood culture at least) plus imaging starting with plain radiographs, the CT with contrast. All of this is proceeded by a careful evaluation of the patient’s ability to protect and maintain their airway.
Red Flags Suggesting a Deep Space Infection Involving the Upper Airway
- Fever > 2 weeks
- Symptom duration >2 wks
- Trismus
- Drooling
- Asymmetric tonsillar swelling or adenopathy
- Swelling in floor of mouth or lateral neck/jaw swelling
- Dysphonia
- Pain out of proportion to clinical findings
- Airway obstruction, dyspnea
- Inability to lay supine