2019 Volume 112 Issue 1 Pages 43-46
The patient was a 58-year-old man with contrast-agent allergy visited a nearby medical clinic with a one-week history of swelling of the neck. He was referred to our hospital with the diagnosis of a retropharyngeal abscess, because CT of the neck revealed a low-density area in the retropharyngeal space. His clinical presentation was, however, not typical for a retropharyngeal abscess, because he had no fever or neck pain. Because of the rather large swelling on the right side of the neck, we additionally performed a chest CT. Chest CT also revealed masses in the right supraclavicular space and mediastinum. Both diffusion-weighted imaging and apparent diffusion coefficient mapping on cervical MRI revealed high-intensity signals in retropharyngeal wall, suggesting that the retropharyngeal swelling represented stasis edema. We performed biopsy of the mass over the right clavicle and made the diagnosis of malignant lymphoma. Conditions that are visualized as low-density areas in retropharyngeal space on cervical CT can broadly be divided into abscess and edema. The two conditions can easily be differentiated by enhanced CT. However, our patient had contrast agent allergy, and we performed MRI as an aid to the diagnosis. Thus, we encountered a didactic case that underscored the importance of examining the whole body for clinical diagnosis.
