Ms. Nga had diabetes, hypertension, dyslipidemia, and recurrent pharyngitis. Recently, she experienced a cough, runny nose, and sore throat. After 7 days, she developed severe neck swelling and difficulty breathing, prompting her to visit Tam Anh General Hospital Ho Chi Minh City. An ear, nose, and throat endoscopy revealed fluid in her middle meatus, a congested pharynx, swollen vocal cords, congested arytenoid cartilage, and turbid fluid in her right piriform sinus and glottis. A CT scan confirmed an abscess measuring 4,5x7x10,5 cm in her neck, extending from the oropharynx to the superior mediastinum.

Dr. Pham Thai Duy, from the Ear, Nose, and Throat Center, stated that the abscess surrounded the brachiocephalic trunk and the right internal carotid artery, compressing the esophagus and subtly shifting the laryngotrachea to the left. Doctors diagnosed congested pharyngitis and a neck abscess.

Dr. Duy explained that properly treated pharyngitis rarely progresses rapidly or severely. Ms. Nga's diabetes and high blood sugar created conditions for the pharyngitis to develop into a severe deep neck abscess complication.

Initially, Ms. Nga received medication to alleviate her symptoms, but significant pus remained. Doctors then recommended emergency surgery to prevent the infection from spreading, which could compress the trachea and cause acute respiratory failure or sepsis.

Bac si Thai Duy (phai) phau thuat cho ba Nga. Anh: Benh vien Da khoa Tam Anh

The surgical team drained the neck abscess. Due to its size, doctors performed a 10 cm skin incision along the sternocleidomastoid muscle and dissected the skin, revealing a widespread pus cavity that had invaded multiple neck spaces. According to Dr. Duy, this diffuse deep neck abscess carried a risk of extending into the mediastinum, which is life-threatening. The mediastinum, the central compartment of the chest, lies between the two lungs and encloses the heart and major blood vessels. When deep neck spaces connect with the mediastinum, pus can spread quickly, leading to an abscess.

The team drained the pus cavity, extracting approximately 100 ml of pus, and cleaned multiple neck spaces. Doctors left the skin incision open and placed gauze to facilitate daily pus drainage, cleaning, and disinfection. Once the infection was fully controlled and no pus remained, doctors would suture the skin to prevent recurrence of the abscess.

After over 10 days, Ms. Nga's health stabilized; her fever subsided, and she resumed normal eating and activities before being discharged.

Dr. Duy advises elderly individuals with underlying conditions to monitor their health closely. If symptoms persist for many days, patients should seek examination for prompt assessment and treatment. He also recommends keeping the neck and chest warm, limiting outdoor exposure when temperatures are low, and following doctors' medication instructions.

Uyen Trinh