Retropharyngeal abscess

Retropharyngeal abscess
A lateral neck X-ray demonstrating soft tissue swelling in front of the vertebrae (marked by the arrow) as seen in a person with a retropharyngeal abscess.
Specialty	ENT surgery
Symptoms	Difficulty swallowing, neck pain, fever, stiff neck, change in voice, large lymph nodes[1]
Complications	Airway obstruction, mediastinitis[1]
Risk factors	Injury to the back of the throat, preceeding upper respiratory tract infection, diabetes, poor oral hygiene[1]
Diagnostic method	Based on symptoms, confirmed by medical imaging[2]
Differential diagnosis	Pharyngitis, epiglottitis, mediastinitis, peritonsillar abscess[1]
Treatment	Antibiotics, endotracheal intubation, incision and drainage[1][2]
Frequency	Uncommon[1]

Retropharyngeal abscess (RPA) is an pus collection located within the tissues of the back of the throat.^[2] Symptoms may include difficulty swallowing, neck pain, fever, stiff neck, change in voice, and large lymph nodes.^[1] Extending the neck may make the symptoms worse.^[1] Onset is often over a few days.^[1] Complications may include airway obstruction or mediastinitis.^[1]

It is often preceded by injury to the back of the throat or an upper respiratory tract infection.^[1] Risk factors diabetes and poor oral hygiene.^[1] Bacteria commonly involved include group A streptococcus, Staphylococcus aureus, Fusobacterium, Haemophilus.^[1] Diagnosis is suspected based on symptoms and confirmed by X-ray or CT scan.^[2]

Treatment includes antibiotics, and possibly endotracheal intubation and incision and drainage.^[1][2] Commonly used antibiotics include ceftriaxone or clindamycin.^[2] Outcomes are generally good with timely treatment.^[2] Retropharyngeal abscesses are uncommon.^[1] While it can also occur at any age, it is most common in children under 5 years old.^[3][1]

Signs and symptoms

Signs and symptoms may include the following stiff neck (limited neck mobility or torticollis),^[4] some form of palpable neck pain (may be in "front of the neck" or around the Adam's Apple), malaise, difficulty swallowing, fever, stridor, drooling, croup-like cough or enlarged cervical lymph nodes. Any combination of these symptoms should arouse suspicion of RPA.

Causes

RPA is usually caused by a bacterial infection originating from the nasopharynx, tonsils, sinuses, adenoids, molar teeth or middle ear. Any upper respiratory infection (URI) can be a cause. RPA can also result from a direct infection due to penetrating injury or a foreign body. RPA can also be linked to young children who do not have adequate dental care or brush their teeth properly.

Diagnosis

A computed tomography (CT) scan is the definitive diagnostic imaging test.^[6]

X-ray of the neck 80% of the time shows swelling of the retropharyngeal space in affected individuals. If the retropharyngeal space is more than half of the size of the C2 vertebra, it may indicate retropharyngeal abscess.^[7]

• 
  Large retropharyngeal abscess as seen on CT
• 
  Large retropharyngeal abscess as seen on CT

Treatment

RPA's frequently require surgical intervention. A tonsillectomy approach is typically used to access/drain the abscess, and the outcome is usually positive. Surgery in adults may be done without general anesthesia because there is a risk of abscess rupture during tracheal intubation. This could result in pus from the abscess aspirated into the lungs. In complex cases, an emergency tracheotomy may be required to prevent upper airway obstruction caused by edema in the neck.

High-dose intravenous antibiotics are required in order to control the infection and reduce the size of the abscess prior to surgery. Chronic retropharyngeal abscess is usually secondary to tuberculosis and the patient needs to be started on anti-tubercular therapy as soon as possible.

References

External links