69 year old female with retropharyngeal abscess. Please evaluate for spread to mediastinum. Images through the skull base and including cavernous sinuses remain within normal limits. Mastoid air cells and paranasal sinuses are also well pneumatized and unremarkable. Images through the soft tissues of the neck demonstrate edematous changes of the retropharyngeal space however no definitive evidence of an abscess is detected. Extensive post therapy changes are identified. Soft tissue prominence at the base of tongue is believed to be artifactual and secondary to placement of endotracheal tube. No definitive evidence of mass is identified. There are no old films available for comparison. No evidence of any abnormal enhancing nodes is detected.Increased soft tissue density with cavity formation is noted in the prevertebral space at the level of the larynx and extends inferiorly to at least to the level of the aortic arch in the mediastinum. The quality of images are very poor and further evaluation with an MRI is recommended. At the level of larynx this cavity contains air and may indicate patient's known abscess. At C6 and C7 within intervertebral disk a small amount of air collection may represent vacuum phenomenon however this is immediately at the level of abscess and although the bony density of the spine is not suggestive of osteomyelitis this possibility cannot be entirely ruled out and further investigation with MRI is recommended. This finding is best appreciated on axial images 63 and 64. The largest transverse diameter of this abscess cavity at the level of C5 -- C6 intervertebral disk space measures 33.2-mm (axial image 64 of 88). The cranial cephalad axis of the abscess measures approximately 82 mm. A component of this lesion within the mediastinum appears more solid and contains male multiple linear areas of increased density which may be vascular. This raises the possibility of a neoplastic process. This finding causes anterior displacement of the trachea and is best appreciated on axial image 76 to 88. The finding at this level on this examination is inseparable from the esophagus.Extensive apical scarring of bilateral lungs is noted. Significant amount of pleural effusion on the left and to lesser degree on the right is noted.
1.Prevertebral abscess extending from the level of the larynx to approximately the level of aortic arch in the mediastinum.2.The intra mediastinum component of this finding is more solid with no air collection and demonstrates multiple vasculature which may indicate presence of the mass in addition to more superiorly located abscess.3.On this examination possibility of osteomyelitis specifically at C6 and C7 cannot be rule out due to apparent continuity of air within the disk space and air within the abscess.