A retropharyngeal abscess is a collection of pus in the back of the throat.
- A retropharyngeal abscess is caused by a bacterial infection.
- Symptoms include difficulty and pain when swallowing, a fever, stiff neck, and noisy breathing.
- The diagnosis is based on symptoms and x-rays or computed tomography of the neck.
- Children who receive prompt treatment do well.
- The abscess is drained surgically, and antibiotics are given to eliminate the infection.
A retropharyngeal abscess forms when lymph nodes in the back of the throat become infected, break down, and form pus. Because these nodes begin to disappear by age 4 to 5 years, retropharyngeal abscesses occur mainly in children age 1 to 8 years and are uncommon in adults.
A retropharyngeal abscess is usually caused by a bacterial infection that has spread from the tonsils, throat, sinuses, adenoids, or nose. (See figure A Look Inside the Throat.) Many infections are caused by a combination of bacteria. HIV infection and tuberculosis are becoming more common causes in adults and children. An injury to the back of the throat caused by a sharp object, such as a fish bone, occasionally causes a retropharyngeal abscess.
A Look Inside the Throat
The main symptoms of a retropharyngeal abscess are difficulty and pain when swallowing, fever, and enlargement of the lymph nodes in the neck. The voice is muffled, and children may drool. The neck may be stiff, and children may hold their head at an angle.
The abscess can block the airway, making breathing difficult and noisy, particularly when children inhale (called stridor). Children may lie on their back, tilt their head and neck back, and raise their chin to make breathing easier. Adults may have severe neck pain but do not always have stridor.
Complications of a retropharyngeal abscess include bleeding around the abscess, rupture of the abscess into the airway (which can block the airway), and pneumonia. The voice box (larynx) may go into spasm and further interfere with breathing. Blood clots may form in the jugular veins of the neck. Infection may spread down into the chest. Sometimes widespread inflammation and infection of the bloodstream occurs, causing organs to malfunction (a condition called septic shock).
- X-rays and computed tomography
A doctor suspects a retropharyngeal abscess in children who have a severe, unexplained sore throat, a stiff neck, and noisy breathing.
X-rays and computed tomography (CT) scans of the neck can confirm the diagnosis.
- A breathing tube followed by surgery to drain the abscess
Most people with a retropharyngeal abscess do well with prompt treatment.
First, people are given antibiotics such as ceftriaxone or clindamycin by vein.
For both children and adults, doctors insert a plastic breathing tube through the mouth into the windpipe (trachea) to keep the airway open. Doctors then cut the abscess open allowing the pus to drain out.