Overview
A retropharyngeal abscess (RPA) is a deep neck space infection describing a collection of purulent material in the space between the pharynx and cervical vertebrae (the retropharyngeal space) and can be life-threatening due to the risk of airway compromise.
Pathophysiology
The retropharyngeal space may become infected due to the spread of infection from the lymph nodes in people with upper respiratory tract infections or via direct inoculation (e.g. endoscopy, intubation, feeding tubes, surgery, and fish bones).
Epidemiology
- RPA is rare in developed countries where antibiotics are used commonly for upper respiratory tract infections
- RPA is more common in younger children (around 2-4 years old), but can affect any age
Risk Factors
- Trauma – endoscopy, intubation, feeding tubes, surgery
- Recent upper respiratory tract infection
- Foreign body ingestion – such as fish bones
- Dental caries, infections, and poor oral hygiene
- Immunocompromised states – such as HIV and immunosuppressant drugs
- Diabetes mellitus
Presentation
Features of a retropharyngeal abscess include:
- A recent risk factor – such as an upper respiratory tract infection or trauma
- Voice change – muffled, hoarse, ‘cri du canard’ or ‘duck quack’ sound
- Dysphagia, drooling, sensation of a lump in the throat, odynophagia
- Systemic upset – fever, rigours, malaise
- Neck stiffness
- Unilateral lymphadenopathy
- An oral examination may identify a mass in the posterior pharyngeal wall
- Difficulty breathing suggests airway obstruction (e.g. stridor)
Management
Overview
Management involves securing the airway and urgently referring to Ear, Nose, and Throat for incision and drainage along with intravenous antibiotics and supportive treatment (e.g. intravenous fluids and analgesia).
Complications
Mass effect – expansion of the abscess may compress the trachea and compromise the airway.
Spread of infection – the abscess may spread or rupture, resulting in inflammation of adjacent tissues, such as mediastinitis, pericarditis, cervical vertebral osteomyelitis, epiglottitis etc.
