Rare diagnosis, but keep on your differential for patients with fever, neck pain/stiffness, dysphagia, drooling, voice change, respiratory distress, or neck mass.
Advanced preparation a must for management of airway! Difficult airway given the size of the mass and airway compression. Call anesthesia early and prep transtracheal jet insufflator for pediatrics. Consider exam in the OR
Lateral neck x-ray cannot rule in or rule out the diagnosis, but may be helpful. Look for increased pre-vertebral soft tissue (indicated RPA) or thumbprint signs of epiglottitis. Get a TRUE lateral to increase sensitivity.
RPAs are complicated by sepsis, carotid rupture, atlanto-axial subluxation, mediastinal extension and airway compromise. Patients require IV antibiotics, ENT consult, and admission.