The Utility of a Second CT Scan in the Management of Parapharyngeal and Retropharyngeal Abscesses in Pediatric Patients

Objective: To evaluate the utility of follow-up CT imaging for predicting the need for surgical intervention in pediatric patients with deep neck infections (DNI) admitted for a trial of observation with medical management. Methods: Pediatric patients admitted with DNI from January 2000 to February 2009 who underwent a CT scan, initial medical management, and repeat CT scan were identified and separated into two cohorts: patients who underwent surgical intervention and patients treated with medical management. Necessity of surgical intervention following the repeat CT scan was determined and the predictive values of CT imaging characteristics and clinical characteristics for identifying necessary surgical interventions were calculated. Results: 62 patients met inclusion criteria. Of the 32 patients who underwent surgical intervention following their second CT scan, 75% revealed an abscess. Of the 30 patients who continued with medical management following the second CT scan, 10% failed medical management. The combination of increased size, increased peripheral enhancement, and walling off of collections on subsequent CT imaging yielded 83% specificity for identifying patients who needed surgical intervention. Interpretation of the collection as a phlegmon or abscess on the repeat CT scan by the radiologist yielded 96% sensitivity for identifying patients who needed surgical intervention. Conclusion: Follow-up CT imaging can assist with determining the need for surgical intervention in children with deep neck infections initially managed medically.