A case of mediastinitis secondary to retropharyngeal abscess.

A 50 year old male patient who consumed chicken bone soup, 4 days back, presented with dysphagia, high grade fever with chills, shortness of breath and swelling in face, neck and upper chest. Patient was toxic and in respiratory distress with room air oxygen saturation of 83%, which increased to 92% with 6 lit of oxygen through simple face mask. Indirect laryngoscopy revealed a retro pharyngeal abscess and CT chest revealed Sub-cutaneous and mediastinal emphysema. The abscess was immediately drained and followed with parenteral anti-microbials and high flow oxygen theapy. Patient improved and was discharged after 12 days. This case was reported as, foreign body causing Retro-pharyngeal abscess is a very rare entity in this anti-biotic era especially leading to a very rare complication of mediastinitis and Pneumomediastinum is unusual.

An unusual case of pseudochylothorax.

A 25-year-old male patient presented with right-sided pleuritic chest pain and pain in the ankle. Radiological investigations revealed a right sided pleural effusion, lytic lesion in spine D10 with paravertebral abscess. Pleural fluid analysis showed elevated lactate dehydrogenase, adenosine deaminase, increased triglycerides, cholesterol, and no chylomicrons. Hence, a diagnosis of pseudochylothorax secondary to tuberculosis was made. Pleural fluid was drained by tube thoracostomy, decortication was done to improve the lung function and patient was started on anti-tuberculosis treatment (ATT). Patient improved with ATT. Pseudochylous effusion or chyliform effusions are uncommon. <200 cases has been reported in the international literature. The possibility of tuberculosis has to be considered in diagnosis and treatment of such cases. Here, we present a case of tuberculous pseudochylous effusion.