Retropharyngeal Abscess

• Physical signs in adults
  • Posterior pharyngeal edema (37%)
  • Nuchal rigidity
  • Cervical adenopathy
  • Fever
  • Drooling
  • Stridor
• Physical signs in infants and children
  • Cervical adenopathy (83%)
  • Retropharyngeal bulge (43%; do not palpate in children)
  • Fever (86%)
  • Stridor (3%)
  • Torticollis (18%)
  • Neck stiffness (59%)
  • Drooling (22%)
  • Agitation (43%)
  • Neck mass (91%)
  • Lethargy (42%)
  • Respiratory distress (4%)
  • Associated signs including tonsillitis, peritonsillitis, pharyngitis, and otitis media

A doctor suspects the disorder 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.

Treatment and Prognosis

Retropharyngeal abscesses often need to be drained surgically. A doctor cuts the abscess open allowing the pus to drain out. Penicillin plus metronidazole, clindamycin , ampicillin -sulbactam, cefoxitin , or other antibiotics are given, at first intravenously, and then by mouth. Most children do well with prompt treatment.