Figure - available from: Ear, Nose, & Throat Journal
This content is subject to copyright.
CT Angiogram Head and Neck with and without contrast on 7/21 compared to CT Soft Tissue Neck with and without contrast on 7/24. A, At presentation 7/21 axial view of edematous appearance of the bilateral palatine tonsils and suppurative left retropharyngeal lymph node. Partial effacement of the oropharynx secondary to tonsillar edema. B, At presentation 7/21 sagittal view findings of pharyngitis/tonsillitis, with retropharyngeal effusion extending from the level of C2 to C3 to C7-T1 with maximum thickness of 12 mm. Multiple enlarged retropharyngeal, cervical, and supraclavicular lymph nodes, likely reactive. C, Interval 3-day follow-up 7/24 status post I & D with decreased retropharyngeal fluid collection now measuring approximately 5 mm thickness. CT indicates computed tomography; I & D, incision and drainage.
Source publication
Our understanding of the novel coronavirus, COVID-19, is growing; yet, there remains much we do not understand, and unique presentations are abundant. One potential presentation is retropharyngeal edema, defined as fluid in the retropharyngeal space. Multiplanar imaging with computed tomography or magnetic resonance imaging is ideal for characteriz...
Citations
... Though literature on this entity secondary to SARS-COV-2 is scarce, its prevalence has been reported to be as high as 2.9% [2]. Considering RPE can rapidly result in life-threatening complications, such as airway compromise and spread of the infection to adjacent spaces and the mediastinum, recognition of the condition and risk factors for its development are as critical as prompt treatment [3]. The report, herein, of a patient with of C1-C7 were seen in the axial (Fig. 1) and sagittal (Fig. 2) windows. ...
... Early detection of such a complication is critical to prevent exacerbation of symptoms that may necessitate the need for surgical intervention to avoid asphyxiation from local inflammation and edema. A previous case report compared treatment in two cases of RPE in SARS-COV-2 positive patients, one of whom was treated conservatively and the other underwent incision and drainage (I&D) [3]. They found that the I&D revealed only serosanguinous fluid without evidence of infection or abscess. ...
... While the I&D reduced the RPE, extubation was unsuccessful and the patient endured further complications in their clinical course. Conversely, conservative treatment of RPE secondary to SARS-COV-2 with antibiotics and close observation has been demonstrated to be adequate enough to resolve the edema and associated symptoms [3]. Conservative management has the added benefit of avoiding additional risks to the patient and healthcare providers inherent to I&D or more aggressive surgical approaches in a SARS-COV-2 positive patient. ...
SARS-COV-2 can cause retropharyngeal edema for which literature on optimal management is sparse. Prompt identification and treatment of the condition is vital to successful recovery. This report presents such a case and offers support for conservative management in treatment of retropharyngeal edema.
... To our knowledge, there are only three reported cases of retropharyngeal infection as a presenting pathology in COVID-19 [1,2] . Our case report is the first to describe retropharyngeal infection as a late complication in an adult with a history of COVID-19 several weeks earlier. ...
Deep neck space infection and viral myocarditis related to coronavirus disease 2019 (COVID-19) have both been described in the medical literature. However, there are only three reported cases of retropharyngeal infection as a presenting pathology in the setting of COVID-19.
A 26-year-old woman presented to the emergency room with fever and neck swelling and pain 1 month after COVID-19 infection. A computed tomography scan of the neck demonstrated tonsillitis with retropharyngeal infection. She was also found to have heart failure with an ejection fraction (EF) of
... COVID-19 have also been described to have retropharyngeal edema [6,7]. All of the patients in this cohort with retropharyngeal edema were treated with antimicrobials in addition to other anti-inflammatory treatment. ...
We defined the prevalence of neck pain, trismus, or dysphagia (28.4%) and retropharyngeal edema (2.9%) among 137 patients with multisystem inflammatory syndrome in children (MIS-c). Retropharyngeal edema or phlegmon has been documented radiologically in at least 9 children. Symptoms of neck inflammation are common in MIS-c.
... To date otolaryngologists have observed an increase in the number of patients with acute parotitis [3,4] and submandibular gland sialadenitis [5], which could be related to CoronaVIrus Disease 19 (COVID-19) when associated to reported general and otolaryngologic symptoms, including fever, anorexia, arthralgia, myalgia, headache, fatigue, nasal obstruction, rhinorrhea, postnasal drip, sore throat, face pain, and loss of smell and taste [6]. Similarly, retropharyngeal fluid collection [7] and peritonsillar or parapharyngeal abscess [8,9] have been reported among the unique presentations of COVID-19. ...
Background
Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature.
Case presentation
We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient’s husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab.
Conclusion
Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.
