Clinical diagnosis of abscesses in infants is very challenging as the symptoms that form the basis of diagnosis such as site of pain,
odynophagia,
gait disturbance etc are difficult to be assessed.
Developing infants have a unique set of susceptibilities and also high risk of accelerated deterioration,
which are not encountered in older children and adults.
Early diagnosis and prompt treatment are hence paramount in infants in which radiology plays a crucial role.
Knowledge of ideal modality is foremost requirement,
which will lead to timely identification while minimizing the number of investigations and avoiding delays in diagnosis.
In accessible sites ultrasound is the initial modality used,
CT and MRI are used in detecting complications and spread of the disease.
For inaccessible sites like retropharyngeal abscesses,
MRI is modality of choice.
Considering the rarity of abscesses in infants often the diagnosis is perplexing and can be mistaken for its mimics.
In our study we assess liver,
lung,
retropharyngeal and muscle abscesses.
Multifocal liver lesions in children are infrequently seen in routine practice.
Imaging plays an important role in the management.
Most of these lesions are initially detected on ultrasound (USG).
MRI helps to characterize these lesions and narrow the differential diagnosis.
In some cases,
in combination with clinical features,
MRI helps to avoid biopsy for the diagnosis.
Children have unique set of predisposing causes for liver abscesses like portal pyemia,
parasitic infection,
chronic granulomatous diseases and protein calorie malnutrition.
Lung abscesses are thick‐walled cavities that contain purulent material and result from an acute pulmonary infection that has led to suppurative necrosis and destruction of the involved lung parenchyma [1].
Treatment with prolonged duration of antibiotics with or without drainage of the abscess cavity has been the standard of care.
It is also important to recognize the complications associated with lung abscesses in children,
and there could be several factors that predispose some patients or increase their risk for having those complications [1].
Lung abscesses have been classified as primary (without any lung or systemic disorders) or secondary (with pre-existing lung or systemic disorders).
Primary pediatric lung abscesses are most commonly caused by Streptococcus pneumoniae [2],
Staphylococcus aureus,
and oral bacteria.
For secondary lung abscesses,
the most common pathogen is Pseudomonas aeruginosa [4].
Fungal infections can be found in patients with secondary lung abscesses.
Prognosis is good for primary lung abscesses [1],
while the nature of the underlying disease is important for determining the outcome of secondary lung abscesses [3].
The retropharyngeal space spans the skull base to the mediastinum and normally contains fat and lymph nodes.
The main causes of fluid expanding the retropharyngeal space can be divided into noninfectious retropharyngeal edema and retropharyngeal infection,
including suppurative retropharyngeal nodes and retropharyngeal abscess [4].
The multiplanar capabilities of CT and MRI are ideal for characterizing and delineating collections.
Important points to remember are that one,
a suppurative retropharyngeal node is contained by the nodal capsule; two,
a retropharyngeal space abscess is contained only by the fascia of the retropharyngeal space and has the potential for devastating complications from mass effect and the spread of infection; and three,
retropharyngeal space edema is noninfectious and resolves spontaneously as its cause is treated [4].
Muscle abscess is a primary infection and suppuration of striated muscles.
It is most commonly reported from tropical countries and is rare in temperate zones,
but has recently been recognized with increasing frequency,
particularly in individuals with human immunodeficiency virus infection (HIV).