Radiology Teaching Files > Case 1133550

Contributed by: J P, Resident, Virginia Mason Medical Center, Washington, USA.
Patient: 58 year old female
History: Severe Sore throat.

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Lateral radiograph shows thickened epiglottis.

CT of the neck shows an abscess involving the pharyngeal mucosal space with lateral extension into the parapharyngeal space.

Diagnosis: Pharyngeal Abscess following a bout of pharyngitis.

Pharyngeal Mucosal Space mass DDx:
1. Asymmetric fossa of Rosenmuller
= lateral pharyngeal recess = asymmetry in amount of lymphoid tissue
2. Tonsillar abscess
sore throat, fever, painful swallowing
3. Postinflammatory retention cyst
1 - 2-cm well-circumscribed cystic mass
4. Postinflammatory calcification
remote history of severe pharyngitis
multiple clumps of calcification
5. Benign mixed tumor
pedunculated mass arising from minor salivary glands
oval / round well-circumscribed mass protruding into airway
6. Squamous cell carcinoma
infiltrating mass with epicenter medial to + invading parapharyngeal space
middle-ear fluid (eustachian tube malfunction)
cervical adenopathy
7. Non-Hodgkin lymphoma
8. Minor salivary gland malignancy
9. Thornwaldt cyst

= midline congenital pouch / cyst lined by ectoderm within nasopharyngeal mucosal space
Origin: persistent focal adhesion between notochord + ectoderm extending to the pharyngeal tubercle of the occipital bone
Incidence: 4% of autopsies
Peak age: 15 - 30 years
asymptomatic incidental finding
persistent nasopharyngeal drainage
foul taste in mouth
Location: posterior roof of nasopharynx
smoothly marginated cystic mass of few mm to 3 cm in size
low density, not enhancing
NO bone erosion
Cx: infection of cyst
DDx: Rathke pouch (occurs in craniopharyngeal canal located anteriorly + cephalad to Thornwaldt cyst)

References: Dahnert.
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Additional Details:

Case Number: 1133550Last Updated: 07-26-2005
Anatomy: Face and Neck   Pathology: Infection
Modality: CT, Conventional RadiographExam Date: 02-10-2005Access Level: Readable by all users
Keywords: pharyngeal abscess

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