Retropharyngeal pseudoabscess manifesting in nephrotic syndrome

May 7, 2014
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Abstract

We describe a case of nephrotic syndrome that manifested as a retropharyngeal pseudoabscess. The patient was a 32-year-old man who presented with a short history of throat discomfort and a choking sensation. Laryngoscopy identified bulging of the posterior pharyngeal wall that partially occluded the laryngeal inlet. A lateral neck x-ray revealed that the prevertebral space was widened, and computed tomography detected fluid in the retropharyngeal and parapharyngeal spaces. Neck exploration revealed that the edema had been caused by nonsuppurative fluid. Biochemical analyses revealed marked hypoalbuminemia and heavy proteinuria suggestive of nephrotic syndrome. Following surgery, the patient's symptoms resolved. Aseptic effusion into the retropharyngeal space is rare; reported etiologies include internal jugular vein thrombosis, neoplasia, radiation therapy, trauma, acute calcific tendinitis, hereditary angioedema, and myxedema of hypothyroidism. To the best of our knowledge, this is the first case of nephrotic syndrome initially manifesting as retropharyngeal pseudoabscess to be reported in the literature. Thrombotic occlusion of the pharyngeal venous plexus secondary to hypercoagulability is a plausible explanation for such isolated retropharyngeal effusion.

Introduction

Widening of the prevertebral space as seen on a lateral neck x-ray is a sign of much concern in ENT practice. The most common and foremost diagnosis is a retropharyngeal abscess. Aseptic effusion into the retropharyngeal space is rare. We describe a previously undiagnosed case of nephrotic syndrome that initially manifested as isolated retropharyngeal space edema and suggested a diagnosis of retropharyngeal abscess. To the best of our knowledge, this is the first such reported case in the literature.

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