Retropharyngeal Abscess 29/09/2022, 9:00 PM

Retropharyngeal Abscess
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Overview and etiology

A retropharyngeal abscess is an abscess in the tissue in the retropharyngeal space which is located at the back of the throat
behind the posterior pharyngeal wall. The retropharyngeal space is bordered by the buccopharyngeal fascia anteriorly, the
prevertebral fascia posteriorly, and the carotid sheaths laterally and extends superiorly to the base of the skull and inferiorly to the
mediastinum. Abscesses in this space were polymicrobial and caused by the following organisms: 

Aerobic organisms, such as group A streptococci and Staphylococcus aureus, including methicillin-resistant S aureus (MRSA)  

Anaerobic organisms, such as species of Bacteroides, Veillonella,Prevotella, Peptostreptococcus, Fusobacterium, and

Porphyromonas 

Gram-negative organisms, such as Pseudomonas (in high-risk groups), Haemophilus influenzae, H parainfluenzae, and others   

Epidemiology
This is a relatively uncommon illness, it is more common in children although it is observed with increasing frequency in adults.
The retropharyngeal abscesses develop most frequently between the ages of 2 and 4 years.  It is more common in males than in
females by 53–55% more cases in males. The overall mortality rate is 1% if the infection reaches a deep cervical space. 

History and symptoms

The following are the symptoms of a retropharyngeal abscess: 

Sore throat 

Croup-like cough 

Fever 

Drooling 

Dysphagia 

Odynophagia 

Neck pain 

Dyspnea 

Physical examination
The following are clinical findings during examination: 

Posterior pharyngeal edema  

Stiff neck (limited neck mobility or torticollis)  

Nuchal rigidity 

Neck tenderness (in front of the neck or around the Adam’s apple) 

Cervical adenopathy 

Fever 

Drooling 

Stridor 

Trismus  

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Retropharyngeal Abscess 29/09/2022, 9:00 PM

Lethargy  

Respiratory distress   

Dysphonia 

Tonsillar displacement 

Associated signs, including tonsillitis, peritonsillitis, pharyngitis, and otitis media in children  

Investigations
Laboratory 

There are no specific investigations needed in order determine the diagnosis, but the following investigation may help: 

CBC with leukocytosis 

Blood culture possibly before administration of intravenous antibiotics 

A culture of exudate, aspirated at the time of surgical drainage of the retropharyngeal abscess 

C-reactive protein may be high with inflammation and if it is greater than 100 patients tend to develop complications and
have prolonged hospitalizations

Erythrocyte sedimentation rate increase in the inflammation  

COVID-19 testing – In adult or pediatric patients who present with a sore throat 

Radiology 

Lateral neck radiography (80% of the time) shows swelling of the retropharyngeal space with more than 7 mm at level C2 vertebra.
The definitive diagnostic imaging  is a computed tomography (CT) scan.  

Management
 Refer patients immediately to an appropriate secondary care facility such as EMS via ambulance. This is a medical emergency with
a high mortality rate.  If you have available, apply supplemental oxygen. Secondary care management may include: 

Intubation 

Intravenous fluids if the patient is dehydrated 

Intravenous antibiotics

Surgical drainage  

The goals of pharmacotherapy are to eradicate the infection, to reduce morbidity, and to prevent complications. Empirical use
of antibiotics such as: 

Ceftriaxone + metronidazole 

Levofloxacin + clindamycin 

Ampicillin-sulbactam 

Prognosis
The mortality rate is high if it is associated with airway obstruction, mediastinitis, aspiration pneumonia, epidural abscess, jugular
venous thrombosis, necrotizing fasciitis, sepsis, and erosion into the carotid artery.

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