Retropharyngeal abscess

Definition
Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. See also Peritonsillar Abscess.

Causes, incidence, and risk factors
Retropharyngeal abscess generally affects children under age 5. Tissues at the back of the throat in young children allow a pus-filled space to form immediately behind the back of the throat. This area can become secondarily infected during or immediately following a bacterial sore throat.

The affected child, who may still have symptoms of the original sore throat, develops a high fever with an extremely severe sore throat. The pain causes difficulty swallowing and the expanding abscess may interfere with breathing. Complications can be life-threatening.

Retropharyngeal abscess requires immediate attention to prevent severe complications.

Symptoms

     
  • prior or present sore throat, infected nose, Tooth abscesses  
  • high fever  
  • severe throat pain  
  • difficulty swallowing  
  • drooling  
  • breathing difficulty  
  • intercostal retractions (the muscles between the ribs pull in when breathing)  
  • stridor (a high-pitched sound when inhaling)

Signs and tests

     
  • X-ray or CT scan of the neck (demonstrates pus filled space between throat and neck vertebrae)  
  • Complete blood count (to check for an elevated white blood count)  
  • Throat culture (to identify the infecting organism, such Group A strep or Staph)

Treatment
Surgical drainage of the abscess and high-dose intravenous antibiotics are used to treat the infection. The airway needs to be protected from becoming completely blocked by the swelling.

Expectations (prognosis)
Full recovery is expected following prompt treatment.

Complications

Calling your health care provider
Call your health care provider if you develop a high fever with severe throat pain. Breathing difficulty, intercostal retractions, and stridor indicate that an emergency situation is developing!

Prevention
Prompt diagnosis and treatment of pharyngitis or upper respiratory infections will generally prevent the development of retropharyngeal abscess.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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