Red Herring in a Patient with Dysphagia.

Kuganathan RAMASAMY, CHO Yin Bee, Norhaslinda ABDUL GANI.

Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja’afar Seremban, Negeri Sembilan, Malaysia.

ABSTRACT     

Dysphagia is a common presenting complaint with a long list of differential diagnoses. Prevertebral abscess is one of the causes that tend to present in a non-specific manner, thus potentiating delayed or even missed diagnosis. We report a 61-year-old lady with underlying Parkinson’s disease who presented with a sudden onset of dysphagia for three days. She was extensively investigated and treated for atypical Parkinson's disease with rapid-onset bulbar palsy without resolution of the dysphagia. Subsequent CT Neck identified a large prevertebral abscess from C4-T4 with mediastinal extension. Incision & drainage via transcervical approach was performed, draining 50cc of pus. We wish to highlight the diagnostic dilemma in this case due to the vague presentation of the prevertebral abscess, complicated by the presence of the pre-existing neurological condition. Complications of prevertebral abscess include mediastinitis and airway compromise, thus the need for prompt diagnosis and treatment. Radiological investigations such as CT should be considered in dysphagic patients without obvious clinical signs during initial presentation to exclude prevertebral abscess.

Keywords: Computed tomography; Dysphagia; Parkinson’s disease; Prevertebral abscess.

Corresponding author: Kuganathan Ramasamy, Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja’afar Seremban, Negeri Sembilan, Malaysia.

Brunei Int Med J.2024;20:114-117