Diagnostyka różnicowa guzów na tylnej ścianie gardła u dzieci

Małgorzata Dębska, Elżbieta Niemczyk, *Lidia Zawadzka-Głos

Summary
Introduction. Infections of the upper respiratory tract in children may result in adenitis of retropharyngeal space. Dysphagia and foreign body sensation are common symptoms.
Aim. Clinical analysis of patients with enlarged retropharyngeal lymph node.
Material and methods. Retrospective study of patients with enlarged retropharyngeal lymph node treated from 2004-2014 in Pediatric Otolaryngology Department of Warsaw Medical University. Following data were analyzed: signs and symptoms, blood tests, medical imaging, diagnosis and management of the patients.
Results. Eight patients aged between 4 years 2 months -11 years 6 months were diagnosed with an enlarged retropharyngeal lymph node. Half of them (n = 4) presented following signs and symptoms: dysphagia, sore throat, foreign body sensation, weight loss, headache. All patients (n = 8) suffered from recurrent upper respiratory tract infections. Otolaryngological examination revealed posterior pharyngeal wall mass in all patients. It was located mainly at the level of upper pole of tonsil or behind tonsil. Five patients were diagnosed with adenoidal or tonsillar hypertrophy or both. Ultrasonography revealed enlarged submandibular lymph nodes in all patients (n = 8). Computed tomography showed either prevertebral space widening or well bounded oval-shaped mass lesion with a homogenous attenuation located posteriorly to the posterior pharyngeal wall, with no enhancement and no infiltration of adjacent structures. All patients underwent surgical excision of the mass. The histopathological examination revealed reactive lymph node enlargement in all patients.
Conclusions. Dysphagia in children may result from presence of a retropharyngeal mass. Differential diagnosis includes reactive enlargement of retropharyngeal lymph nodes.

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