| Retropharyngeal abscess | |
|---|---|
 | |
| A lateral cervical spine X-ray demonstrating prevertebral soft tissue swelling (marked by the arrow) as seen in a person with a retropharyngeal abscess | |
| Specialty | Otorhinolaryngology  |
Retropharyngeal abscess (RPA) is anabscess located in the tissues in the back of the throat behind the posterior pharyngeal wall (theretropharyngeal space). Because RPAs typically occur in deep tissue, they are difficult to diagnose byphysical examination alone. RPA is a relatively uncommon illness, and therefore may not receive early diagnosis in children presenting withstiff neck,malaise,difficulty swallowing, or other symptoms listed below. Early diagnosis is key, while a delay in diagnosis and treatment may lead to death.Parapharyngeal space communicates with retropharyngeal space and an infection of retropharyngeal space can pass down behind theesophagus into themediastinum.[1] RPAs can also occur in adults of any age.
RPA can lead toairway obstruction orsepsis – both life-threatening emergencies.[2] Fatalities normally occur from patients not receiving treatment immediately and suffocating prior to knowing that anything serious was wrong.
Signs and symptoms may include the followingstiff neck (limited neck mobility ortorticollis),[3] some form ofpalpable neck pain (may be in "front of the neck" or around theAdam's apple),malaise, difficulty swallowing,fever,stridor, drooling,croup-like cough or enlarged cervicallymph nodes. Any combination of these symptoms should arouse suspicion of RPA.[citation needed]
RPA is usually caused by a bacterial infection originating from thenasopharynx,tonsils,sinuses,adenoids,molar teeth ormiddle ear. Anyupper respiratory infection (URI) can be a cause. RPA can also result from a direct infection due to penetrating injury or aforeign body. RPA can also be linked to young children who do not have adequate dental care or brush their teeth properly.[citation needed]
A computed tomography (CT) scan is the definitive diagnostic imaging test.[4]
X-ray of the neck often (80% of the time) shows swelling of the retropharyngeal space in affected individuals. If theretropharyngeal space is more than half of the size of the C2 vertebra, it may indicate retropharyngeal abscess.[5]
RPAs frequently require surgical intervention. Atonsillectomy approach is typically used to access/drain the abscess, and the outcome is usually positive. Surgery in adults may be done without general anesthesia because there is a risk of abscess rupture during tracheal intubation. This could result inpus from the abscess aspirated into the lungs. In complex cases, an emergency tracheotomy may be required to prevent upper airway obstruction caused by edema in the neck.[citation needed]
High-dose intravenousantibiotics are required in order to control the infection and reduce the size of the abscess prior to surgery. Chronic retropharyngeal abscess is usually secondary totuberculosis and the patient needs to be started on anti-tubercular therapy as soon as possible.[citation needed]
