What is a retropharyngeal abscess?

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Retropharyngeal abscesses are uncommon but potentially life threatening conditions. They mainly occur in children under 5 years, but people of any age can develop them.

The retropharyngeal space (RPS) is a deep compartment of the head and neck that runs from the base of the skull into the chest cavity. The RPS mainly houses fatty tissues and lymph nodes, some of which decrease in size as a person ages. Therefore, children are more at risk of infection in this area.

Sometimes doctors refer to retropharyngeal abscesses as deep neck space abscesses.

Studies indicate that cases of retropharyngeal abscesses increased between 2003–2012 in the United States, and male children predominantly experienced the infections.

Learn more about the lymphatic system.

Symptoms of a retropharyngeal abscess may include those present in other conditions, such as a sore throat or fever. Some symptoms that may help doctors diagnose a retropharyngeal abscess include:

• spiking fever
• difficulty or pain when swallowing
• neck pain
• head twisted at an angle which doctors refer to as torticollis
• a reduction in drinking
• loss of appetite
• irritability
• malaise
• chest pain
• difficulty breathing
• trismus, also known as lockjaw
• change in voice

Infection involving lymphatic drainage in the neck, middle ear, or sinuses may lead to a retropharyngeal abscess. The two most common causes of retropharyngeal abscesses are pyogenic lymphadenitis and peritonsillar abscesses, which are infections involving the lymph glands, head, and neck.

A prior upper respiratory tract infection is present in half of all cases of retropharyngeal abscesses, and a quarter of cases are due to trauma to the throat area, known as the pharynx. In addition, infections of the tonsils and teeth can evolve into retropharyngeal abscesses.

Bacteria, such as Streptococcus pyogenes and Staphylococcus aureus, commonly cause retropharyngeal infections.

Additionally, experts advise that risk factors for RPS infection include:

• poor oral hygiene
• a compromised immune system
• diabetes
• low socioeconomic status

Many people with retropharyngeal abscesses delay seeking medical care, thinking they have a respiratory tract infection.

Symptoms of a retropharyngeal abscess may be nonspecific, for example, a sore throat or fever. Therefore, doctors need to perform further tests to diagnose the condition.

A doctor may recommend blood tests if they do not cause additional distress and affect the airways, which may occur in younger children. Someone may also need an X-ray or CT scan of the neck or chest. In addition, doctors may use ultrasound for children as it does not involve radiation.

Healthcare professionals often make a differential diagnosis. Some other conditions with similar symptoms include pneumonia, a foreign body in the airways, or pharyngitis.

If a retropharyngeal abscess obstructs the airways, it can cause breathing difficulties or even be fatal.

Other complications of a retropharyngeal abscess include:

• bronchial erosion, which affects bronchi or air passages in the lungs
• sepsis
• acute respiratory distress syndrome
• erosion into the carotid artery or jugular vein
• meningoencephalitis, which involves inflammation of the meninges and the brain
• cranial nerve palsies, which is when one or more cranial nerves do not function
• esophageal perforation, which is when a hole develops in the esophagus
• mediastinitis, which is inflammation of tissues in the middle part of the chest

Additionally, people who need surgery may require rehabilitation or therapy to regain joint movement, muscle strength, and speech.

Anyone with a confirmed diagnosis of retropharyngeal infection will require hospital admission, intravenous antibiotics, and otolaryngology consultation. Doctors usually need to treat people with a retropharyngeal abscess in an intensive care unit, as over 40% of cases result in death.

As a retropharyngeal abscess grows, it can obstruct the airway and cause breathing difficulties or suffocation. In these cases, a doctor performs an immediate surgical incision and drains the abscess. Guidelines state that abscesses greater than 2 centimeters with symptoms for 2 days or more warrant surgical intervention.

After a person clinically improves and their fever subsides, doctors may replace intravenous antibiotics with oral antibiotics for 14 days. After that, the doctor may discharge the individual with strict instructions to monitor their condition at home.

Below are some common questions and answers about retropharyngeal abscesses.

Is a retropharyngeal abscess an emergency?

Without treatment, a retropharyngeal abscess can cause upper airway obstruction and asphyxiation. Therefore, a doctor will treat the condition as a medical emergency.

Are retropharyngeal abscesses common?

Retropharyngeal abscesses are uncommon, mainly occurring in children aged 5 years and under.

What can prevent a retropharyngeal abscess?

People should consult a doctor as early as possible if they have any upper respiratory symptoms or fever to prevent infection from worsening or leading to a retropharyngeal abscess. In addition, experts advise that maintaining good oral hygiene and having a dentist perform regular checkups may help to prevent infections.

Retropharyngeal abscesses are uncommon childhood conditions that can potentially cause death. The condition can also occur less frequently in adults.

People with symptoms of a retropharyngeal abscess, such as fever, difficulty swallowing, or their heads twisted at an angle, should seek medical attention immediately. Retropharyngeal abscesses sometimes result from a respiratory tract infection, tonsilitis, or dental infection.

A retropharyngeal abscess may obstruct a person’s airways and cause suffocation, so doctors treat the condition as a medical emergency. Doctors usually admit people to intensive care and may treat them with antibiotics or surgery.