Retropharyngeal abscess

Background

• Polymicrobial abscess in space between posterior pharyngeal wall and prevertebral fascia
• Adults: Due to direct extension of purulent debris from adjacent site (e.g. Ludwig angina)
  • More likely to extend into the mediastinum
• Children: Due to suppurative changes within a lymph node (primary infection elsewhere in head or neck)
• Trauma: Direct inoculation (e.g. child falling with stick in mouth)

Clinical Features

• Sore throat (76%)
• Fever (65%)
• Torticollis (37%)
• Dysphagia (35%)
• Late symptoms:
  • Stridor, respiratory distres, chest pain (mediastinitis)

Diagnosis

• CT neck w/ IV contrast
  • Gold standard

• XR Soft tissue
  • The prevertebral space should be less than 7mm at C2, 14mm at C6 in children regardless of the age
  • The prevertebral space should be less than 22mm at C6 in adults
  • If the prevertebral space should be less than one-half the width of the corresponding vertebral body
  • If equivocal XR, order CT

Treatment

• Emergent ENT consult
  • Most patients require I&D
• Secure airway

Antibiotics

• • Clindamycin 600-900mg IV OR
  • cefoxitin 2gm IV OR
  • Ampicillin/Sulbactam 3g IV

Disposition

• Admit

See Also

1. PTA
2. Ludwig's Angina
3. Pharyngitis

Source

• Tintinalli
• emedicine.com
• Emergency Medicine Oral Board Review Illustrated, Okuda