Prompt restoration of airway along with rapid neurological recovery following ultrasonography-guided needle aspiration of a tubercular retropharyngeal abscess causing airway obstruction

Borgohain B
Correspondence: Dr Bhaskar Borgohain, bhaskarborg@gmail.com

ABSTRACT
Upper respiratory obstruction in cervical spine tuberculosis rarely occurs due to retropharyngeal cold abscess or secondarily from its rupture. Options for securing the airway are intubation, tracheostomy and needle aspiration or surgical drainage. A young boy presented with neck pain, quadriparesis and stridor, suggesting subacute airway obstruction in advanced tubercular spondylodiscitis of cervical spine C3–C4 (cervical 3rd and 4th level) with extradural compressive myelopathy (C3–C5) and a large retropharyngeal cold abscess. An urgent ultrasonography-guided needle aspiration with a head low position through the left posterior triangle was performed with adequate precautions and back-up for advanced airway management. Needle aspiration yielded 200 ml of pus. Stridor and hoarseness of voice decreased immediately. Within two-and-a-half hours, the patient improved neurologically. Although guided needle aspiration is one of the treatment options, there is a strong tendency to undermine this technique in favour of other options, especially surgery.

Keywords: airway obstruction, needle aspiration, neurological recovery, retropharyngeal abscess
Singapore Med J 2011; 52(11): e229-e231