Retropharyngeal abscess

Published on 23/06/2015 by admin

Filed under Emergency Medicine

Last modified 23/06/2015

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14.4 Retropharyngeal abscess

James Tilleard

Essentials

1 The potential for airway compromise and other complications mandates early diagnosis and treatment.
2 Retropharyngeal abscess should be suspected in children with sore throat, neck pain, fever, dysphagia, dysphonia, neck swelling or torticollis.
3 The differential diagnosis includes meningitis and epiglottitis.
4 Antibiotics must be initiated early.
5 Patients should be managed in an institution with appropriate paediatric medical, surgical, anaesthetic and intensive-care facilities.

Introduction

Retropharyngeal abscess is an uncommon condition with the potential for significant complications including airway compromise. Retropharyngeal abscess formation occurs in the space between the fascia covering the posterior pharyngeal wall and the pre-vertebral fascia. The related parapharyngeal abscess occurs in the deep neck space lateral to the pharynx containing the carotid sheath and cranial nerves.

Retropharyngeal abscess in the paediatric population is usually secondary to upper respiratory tract infection and suppuration in retropharyngeal lymph nodes. Other causes include infection following trauma, foreign body ingestion or dental problems. While abscess formation may occur at any age, the peak incidence is in children aged less than 6 years.

The most common causative organisms are group A β-haemolytic streptococci and Staphylococcus aureus. Anaerobes, especially Bacteroides

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