Carotid Space: A Rare Location of Cervical Abscesses

Introduction: Deep cervical spaces infections are rare entities in pediatric age and may be associated with significant percentages of morbidity and mortality.

Case Presentation Summary: We present the case of a four-year-old girl, previously healthy, admitted to our emergency room with a 3 days history of neck pain and fever. She had odynophagia and fever, two weeks before. Physical examination showed tenderness of the cervical region, without trismus, and bilateral cervical infracentimetric adenopathies. Otoscopy showed signs of acute otitis media on the right and serous otitis on the left, hyperemia and tonsillar hypertrophy with tonsillar exudate. On blood analysis presented leukocytosis, neutrophilia and C-reactive protein 79 mg / L. She started intravenous (IV) antibiotics with amoxicillin and clavulanic acid. During the hospitalization a cervical ultrasound revealed an increase in the echogenicity of the adipose planes of the right carotid space (RCS), a finding that led to a cervical CT scan, which showed a liquid collection at the level of the upper third of the RCS, with 25x15 mm compatible with abscess, with significant reduction of the right carotid artery diameter. Significant clinical improvement was observed after she started IV antibiotis, but due to the location of the abscess and the absence of improvement in the imaging tests, methylprednisolone IV was started and the patient was transferred to a Central Hospital. During hospitalization clindamycin was added to the therapeutic scheme, with progressive improvement and without the need for surgical drainage.

Discussion: Carotid space infections, due to their location and structures, are associated with potentially fatal complications. Early diagnosis is essential. However, as it is a rare pathology, with varied clinical features and nonspecific findings on physical examination, it becomes a diagnostic challenge that requires a high degree of clinical suspicion.