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Retropharyngeal abscess

Definition

Retropharyngeal abscess is a collection of pus in the tissues in the back of the throat. It is a potentially life-threatening medical condition.

See also:

• Ludwig's angina
• Peritonsillar abscess

Causes, incidence, and risk factors

Retropharyngeal abscess generally affects children under age 5, but it can occur at any age.

Infected material (pus) builds up in the space around the tissues at the back of the throat. This can occur during or immediately after a throat infection.

Symptoms

• Breathing difficulty
• Difficulty swallowing
• Drooling
• High fever
• High-pitched sound when inhaling (stridor)
• Muscles between the ribs pull in when breathing (intercostal retractions)
• Severe throat pain

Signs and tests

The health care provider will perform a physical exam and look inside the throat. The doctor or nurse may gently rub the back of the throat with a cotton swab, so that a sample of tissue can be more closely examined. This is called a throat culture.

Other tests may include:

• Complete blood count (CBC)
• CT scan of the neck
• X-ray of the neck

Treatment

Surgery is needed to drain the infected area. Corticosteroids are sometimes given to reduce airway swelling. High-dose antibiotics are given through a vein (intravenous) to treat the infection.

The airway will be protected so that it does not become completely blocked by the swelling.

Support Groups

Expectations (prognosis)

It is important to get immediate medical help. This condition can lead to blockage of the airway, which can be life-threatening. With prompt treatment, you can make a full recovery.

Complications

• Airway obstruction
• Aspiration
• Mediastinitis
• Osteomyelitis

This list may not include all types of complications.

Calling your health care provider

Call your health care provider if you or your child develops a high fever with severe throat pain.

Seek immediate medical help if you have:

• Breathing difficulty
• High-pitched breathing sounds (stridor)
• Muscles between the ribs pull in when breathing (intercostal retractions)

Prevention

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

References

Shirley WP, Woolley AL, Wiatrak BJ. Pharyngitis and adenotonsillar disease. In: Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa; Mosby; 2010:Chap 196.

Duncan NO. Infections of the airway in children. In: Cummings CW, Flint PW, Haughey BH, et al. Otolaryngology: Head & Neck Surgery. 5th ed. Philadelphia, Pa; Mosby; 2010:Chap 197.

Melio FR. Upper respiratory tract infections. In: Marx JA, Hockberger RS, Wallis RM, et al, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 7th ed. Philadelphia, Pa: Mosby; 2006:chap 73.