This infection, as with other deep neck space infections, is usually of odontogenic origin and then spreads along tissue planes. This infection can also spread contiguously from a focus of vertebral osteomyelitis or epidural abscess. Penetrating trauma of the pharynx (chicken bone) or instrumentation is another risk factor for this infection. Infections of the retropharyngeal space can extend to involve the lateral pharyngeal space, the carotid sheath, and the mediastinum. Acute necrotizing mediastinitis is a feared complication with high mortality.
Organisms usually involved in this infection are mouth flora including group A Streptococcus, Staphylococcus aureus, Fusobacterium species, Prevotella species, and other oral anaerobes. Infection is frequently polymicrobial.
Infants and children may present with pharyngitis and dysphagia, resulting in poor oral intake, fever, neck stiffness or swelling, and cough. Adults may present with odynophagia, neck pain, fever, and dyspnea.
A CT scan of the neck with contrast can identify a retropharyngeal abscess. Treatment involves surgical drainage in addition to antibiotic therapy.
J39.0 – Retropharyngeal and parapharyngeal abscess
18099001 – Retropharyngeal abscess
- Cervical osteomyelitis – more likely if there is not an obvious paratonsillar abscess seen on imaging
- Calcific tendinitis of the longus colli muscle – imaging reveals the calcifications
- Kawasaki disease – in children, this disease is often associated with a fluid collection in the retropharyngeal space (without rim enhancement)
- Lymphoma – not associated with fluid collections
- Retropharyngeal hematoma – patients may have a history of trauma or be at increased risk of bleeding due to anticoagulation