病初期に咽後膿瘍類似の画像所見を呈した川崎病症例を経験したので報告する。
  症例は 5 歳男児。発熱，咽頭痛，頸部リンパ節腫脹にて発症。小児科にて抗生剤内服，点滴投与にても改善せず。頸部 CT にて咽頭後壁に low density area を認めたため，咽後膿瘍疑いにて耳鼻科紹介となった。頸部造影 MRI を施行し，リンパ節の集簇を疑わせる病変を認め，最終的に川崎病不全型と診断した。病初期に咽後膿瘍を疑わせるも最終的に川崎病と診断しえたまれな症例を経験したので若干の文献的考察を加え報告する。

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The necessity to differentiate between Kawasaki disease and retropharyngeal abscess has been emphasized in recent years, as the clinical symptoms and laboratory findings of the two conditions may be similar. One of the findings useful to distinguish between the two is that on contrast-enhanced computed tomography (CT), a retropharyngeal abscess is visualized as a low-density area (LDA) with ring enhancement, whereas Kawasaki disease is usually visualized as a LDA without ring enhancement. We report three cases of Kawasaki disease mimicking retropharyngeal abscess, in which enhanced CT revealed a LDA with partial or total ring enhancement in the retropharyngeal space. The patients presented with high fever, neck pain and cervical swelling, and since cervical lymphadenitis was suspected, they were treated with antibiotics, although these proved ineffective. The patients were finally diagnosed as having Kawasaki disease, and improved promptly with intravenous immunoglobulin (IVIG) therapy and aspirin. Thus, even in cases showing a LDA with ring enhancement on enhanced CT, the possibility of Kawasaki disease cannot be entirely excluded.

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We report a case of Kawasaki disease mimicking a retropharyngeal abscess. A boy aged 7 years and 11 months was hospitalized after 4 days with a high fever and cervical lymphadenopathy. Contrast-enhanced head and neck computed tomography (CT) showed a low-density lesion in the posterior pharyngeal space. Having all 6 clinical criteria for Kawasaki disease on hospital day 2, the boy was treated with γ-globulin, ibuprofen, and antibiotics, which gradually alleviated all clinical signs.
An abscess-like retropharyngeal lesion is considered a manifestation of Kawasaki disease. Cervical lymphadenopathy is the presenting symptom in only 12% of subjects with Kawasaki disease, and may significantly delay diagnosis. It is therefore important when examining a child with a retropharyngeal abscess to consider the possibility of Kawasaki disease.

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We report a case of Kawasaki disease with high fever and cervical lymphadenitis. A 4-year-old boy admitted for high fever and severe pain of neck had cervical lymphadenopathy, including a fever of over 38°C, and slightly swollen tonsils. Computed tomography (CT) later indicated a retropharyngeal cellulitis. Based on these findings, we treated the boy with antibiotics alone until skin changes typical of Kawasaki disease, reddening and rashes on the palms and soles, appeared.
Kawasaki disease should therefore be considered a possibility in children with cervical lymphadenopathy, presenting symptoms such as high fever resistant to antibiotics.

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  2005年 1 月から2011年 4 月の間に滋賀医科大学病院で川崎病と診断した106例中 4 例（3.8%）に，頸部造影 CT で咽後間隙に ring enhancement を伴わない低吸収域が認められた。それら 4 症例の年齢は 1 歳，5 歳，6 歳，11歳で，平均5.6歳であった。初発症状は全例発熱と頸部リンパ節腫脹で，頸部リンパ節炎として抗菌薬の投与が行われたが改善しなかった。その後数日で苺舌や不定形発疹など他の主要症状が出現し，川崎病と診断した。川崎病の診断後，γ グロブリンとアスピリンの投与が行われ症状は改善し，咽後間隙の低吸収域も外科的な排膿処置を施すことなく軽快した。
  抗菌薬への反応に乏しい小児の頸部リンパ節炎症例で咽後間隙の低吸収域が認められた場合は，ring enhancement の有無を確認することで川崎病の早期診断につながる可能性が示唆された。

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The necessity to differentiate between Kawasaki disease and retropharyngeal abscess has been emphasized in recent years, as the clinical symptoms and laboratory findings of the two conditions may be similar. One of the findings useful to distinguish between the two is that on contrast-enhanced computed tomography (CT), a retropharyngeal abscess is visualized as a low-density area (LDA) with ring enhancement, whereas Kawasaki disease is usually visualized as a LDA without ring enhancement. We report three cases of Kawasaki disease mimicking retropharyngeal abscess, in which enhanced CT revealed a LDA with partial or total ring enhancement in the retropharyngeal space. The patients presented with high fever, neck pain and cervical swelling, and since cervical lymphadenitis was suspected, they were treated with antibiotics, although these proved ineffective. The patients were finally diagnosed as having Kawasaki disease, and improved promptly with intravenous immunoglobulin (IVIG) therapy and aspirin. Thus, even in cases showing a LDA with ring enhancement on enhanced CT, the possibility of Kawasaki disease cannot be entirely excluded.

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The purpose of this paper is to evaluate the adaptive reuse of saw-tooth roof factories in Kiryu City from the aspect of the preservation of regional characteristics and local industry. Kiryu City has had an active textile industry since the Edo era and 272 saw-tooth roof factories were found by a research in 2005, some in operation and some in adaptive reuse. Currently 25 factories are found to be reused in new various functions. The evaluation criteria were determined based on historical and industrial features of Kiryu City, and organized into 3 perspectives: macro, meso and micro. The macro perspective criterion focuses on whether the location of the textile factory is in the area facing a river. The meso perspective criterion examines whether 3 facilities (saw-tooth roof factory, dwelling and warehouse) are still existing in one site. The micro perspective criteria examine whether the room is kept void, and whether textile products are being used. The results of the evaluation show that the current adaptive reuse cases display the characteristics of Kiryu City only to a limited extent. Therefore, integrated plans covering all three perspectives are needed, to better preserve the regional characteristics and local industry to the future.

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