Pembimbing :

dr. Agus Sudarwi Sp.THT-KL

Dr. Afif Zjauhari Sp.THT-KL
Presented by :
Hanny Fuzi Lestari
Millatiazmi Maulida
Nadia Mailina

Title of journal :
The Utility of a Second CT Scan in the
Management of Parapharyngeal and
Retropharyngeal Abscesses in Pediatric
Patients
Authors :
Charles A. Elmaraghy1*, Justin B Mahida2,
Charles P Pluto3, Peter C Minneci2, Katherine J
Deans2, Nathan Cass4 and Andrew Tompkins5
Published by :
Avens Publishing Group
Inter J Otorhinolaryngology
April 2015 Volume 2, Issue 1

Retropharyngeal
(RP) and
parapharyngeal
(PP) infections

the most
common deep
neck
infections
(DNI) in
children

Need CT scan
for initial
evaluation of
pediatric DNI

To confirm the presence of

infection, to determine its
stage, and to provide
surgeon with anatomical
guidance

NO STUDY TO
DATE HAS
ANALYZED

to determine the utility of

repeat CT imaging in
pediatric patients with DNIs
for predicting the need for
surgical intervention
following a trial of medical
management.

Study Design
Subject

A retrospective review between

January 2000 and February 2009.

pediatric (age < 18 years) patients

with RP or PP infections from a large
pediatric hospital.

inclusions

Exclusions

pediatric (age < 18 years) patients

with RP or PP infections.
patients documented by an
otolaryngology attending physician
Patients who received at least two
CT scans

-Patients who did not undergo

repeat imaging
-Ultrasound used for imaging
-Images unavailable for review

Following variables

Age, sex, anatomic location of infection, presenting

white blood cell (WBC) count, antibiotic treatment
given, number of days between CT scans, second CT
scan whether the patient was taken to the operating
room and if so, whether pus was obtained at surgery.

Blinded review of
the initial and
follow up CT scan
by two pediatric
radiology

To determine the
progression of the
lession

Volume was calculated to determine

if the lession had increased in size.
Peripheral enhancement was
compared.
Second CT scan was evaluated of
wall thickening.

Four categories of interpretation:

1.No pathologic findings
2.Edema or developing phlegmon
3.Phlegmon or developing abscess
4.abscess

Comparisons

Needing surgery

Not needing surgery

Population who went to

operating room VS those who
did not

Patients who underwent surgery and revealed

purulent drainage and also medical treatment
failures

Patients who underwent surgery but did not

revealed purulent drainage and had resolution by
medical treatment

Study Assesment

Sensitivities and
specificities

Five different
radiologic of follow up
CT scans

1.
2.
3.
4.
5.

increased size
increased peripheral enhancement
presence of wall thickening of the lesion on repeat CT
evidence of all three of these findings
characterization of the lesion as a phlegmon or abscess
by the radiologist on repeat imaging.

Data
Analysis
Continuous
variables

using t-tests
with 95%
confidence
intervals

Categorical
variables

using Fishers
exact tests

Data
Analysis
sensitivity

specifity

Patients with positive CT findings who needed

surgical intervention and those with negative
CT findings who needed surgery

Patients with positive CT findings who did not

need surgical intervention and those with
negative CT findings who did not need surgery

32 patients in operative group

had addition to receiving IV
antibiotics.
30 patients in nonoperative
group were treatred with IV
antibiotics alone.

The results are :

1. Patients undergoing surgery VS. Patients who did not
undergo surgery (table 2)
2. Patients in whom purulent drainage was encountered at
surgery VS. Those who did not need surgery (table 3)
3. Sensitivity and specificity (table 4)

1. Patients
undergoing surgery
VS. Patients who did
not undergo surgery

Patients undergoing
surgery more
frequently
demonstrated

increased
peripheral
enhancement
Discrete wall
thickening on the
second CT scan
Progression
Phlegmon or
abscess on the first
and second Ct scan

2. Patients in whom
purulent drainage VS.
Those who did not
need surgery

Patients with needing

surgery

Variable significantly
associated :
1.Walling of the lesion
on the second CT
2.Presence of a
phlegmon or abscess
on the second and the
first CT scan
3.Waiting days
between CT scan
4.Increased peripheral
enhancement
5.Progression
6.Increased size

Presence of a phlegmon or abscess on the second CT is

96% of sensitivity and 54% of specificity.
3. Sensitivity and
specificity

Combination of increased size, peripheral enhancement,

and walling off of the lesion is 37% of sensitivity and
83% of specificity.

The results of the study demonstrate that preoperative

information from repeat CT imaging are more predictive in
identifying patients who should undergo surgery than
clinical information alone.
Antibiotic is not important to decide wheater the patient
needs surgery or not.
The need of surgery is not only determine by second CT
Scan findings, but also the clinical patterns.
CT imaging is more usefull for determining the need for
surgery and providing for anatomical guidence to the
surgeon than ultrasound imaging.

Ct Scan can incerased risk of develoving tiroid cancer, so MRI

can become alternative diagnostic.
The ability of the CT scan to detect clinically significant
increases in size or peripheral enhancement grows.
The study adds to the existing literature by supporting second
CT imaging is useful further characterizing patients who need
surgery.
Limitations of the study are took too long period and being held
in one hospital only, and additionaly, the reseacher defined
patients who underwent surgery but did not reveal purulent
drainage as those who did not need surgery.

The need of surgery in this study only

decided by the present of pleghmon or
abscess in the second CT Scan imaging.
Future endeavors could include
comparing CT with MRI for predicting
surgical necessity.