0:00

So this was a case of a patient that ended up having a fever and

0:05

left-sided neck pain and, uh, hung.

0:08

What did you think this was when you dictate I can't, um,

0:11

I haven't really tried to link the people with the reports.

0:15

I tried to stay somewhat anonymous, but What was your thoughts on this?

0:19

I think it's just you and I on the call. Um, what, what did you think this was?

0:24

I, I know the location is not the retro pharyngeal abscess because it's a paraic

0:29

line. Good. Because it's very common in the children to be a retro pharyngeal,

0:34

if not infection. But for this case,

0:38

I didn't notice the recal pharyngeal effusion because I do concentrate

0:43

on that at the nineties.

0:47

Good. So what was your thoughts then?

0:51

So I will, uh, at that time I put,

0:54

I put a answer of retro pharyngeal at the nineties,

0:57

supposed to be separative at

0:59

The nineties. Nineties, right? Yeah, yeah. So you were the Yeah, exactly. So,

1:02

perfect. So this one actually on the right hand side, this is actually,

1:06

this would, you could consider retropharyngeal adenitis,

1:10

but on the left hand side you can see there's fluid in it.

1:12

So this would be the sive Adenitis.

1:14

And then when we look at the retropharyngeal space, sorry about that.

1:20

Uh, then you could actually start seeing the edema here involved in the retro

1:23

pharyngeal space and these vessels, I mean in, in a, with a leap of faith,

1:27

these vessels that are going midline sort of approximate the location of the

1:31

alar fascia. So remember in the retro pharyngeal space,

1:34

there's a linear fascial layer that bisects the space.

1:37

So this is the true retro pharyngeal space, and this is a dangerous space.

1:41

So this vessel that traverses, it approximates the, the location of the,

1:47

um, alar fascia. So, but correct,

1:50

this is a case of separative adenitis regular, uh,

1:55

retro pharyngeal adenitis on the right side.

1:57

And then we have retro pharyngeal space edema.

2:01

So any questions about that?

2:04

So Dr. Ji, when we see this kind of vessel,

2:07

we can quite certainly to know that there is a patient in

2:12

this space.

2:14

Sorry about that.

2:15

No, I mean the vessel that we saw in this, in the middle, the S line, yeah.

2:20

Is it means it's the ala phi. Mm.

2:25

I would just say, so

2:26

The way you see this is unlikely to be ab access because in the, in the middle.

2:29

Yeah.

2:30

Yeah. I think that's true. Yeah. I think that's a good way to look at it.

2:32

In general, if this was an abscess, that vessel would not be visualized.

2:36

Okay. Yeah. Because to me the,

2:39

the visual visual space is very confusing.

2:42

There are so many different terms and,

2:46

and many people have different talks of, uh, space.

2:50

Yes.

2:51

But this case, okay,

2:52

because I have seen one of the case like this in the children without definite

2:58

peripheral ring enhancement mm-hmm. Is thought to be effusion.

3:02

But I sometimes I will be over reporting. Mm-hmm.

3:06

Just for the T surgeon to have a look. Not sure at the mo.

3:11

Sometimes I'm not sure. I just better to be on the, on the wrong side.

3:16

That's exactly right. Yeah. A hundred percent right.

3:19

Because you don't necessarily wanna miss an abscess.

3:21

And sometimes I have to waffle a little bit. I mean,

3:23

I've just seen so many of these that I've got a better sense of, you know,

3:27

what this is, but, um, but your, your, your approach is exactly right.

3:32

So is separative factor 90 is more common in the children and we see these

3:37

In the adult. Yeah. Yeah. I've seen it in adults as well too. In general,

3:41

it's a little bit more common in kids why that's the case.

3:43

I'm not a hundred percent sure.

3:45

I think maybe it's 'cause kids get more infections involving the throat so they

3:48

get more tonsillitis, they get more, uh,

3:51

infections involving the posterior pharyngeal wall. Maybe that's the case.

3:55

But otherwise, um, I don't really know the cause.