Retropharyngeal abscess in Child
RPA may also result from trauma or extension of tonsillar or dental infections. Infections are generally polymicrobial with organisms that include Streptococcal pyogenes, Staphylococcus aureus, Haemophilus influenzae, Pseudomonas spp, and Fusobacterium spp, as well as other oral anaerobic organisms. Symptoms include fever, neck pain, nuchal rigidity, pharyngitis, and cervical adenopathy. Other symptoms include dysphagia, drooling, and trismus. Patients often refuse to extend their necks due to pain and a neck mass. Torticollis or a muffled voice may be observed. The abscess can compress the airway, resulting in stridor and respiratory distress.
Untreated RPA may progress to mediastinitis with a mortality rate that approaches 25%. Other serious sequalae include pericarditis, internal jugular thrombosis, and epidural abscesses. While uncommon, the incidence of RPA has been increasing.
J39.0 – Retropharyngeal and parapharyngeal abscess
18099001 – Retropharyngeal abscess
Differential Diagnosis & Pitfalls
- Epiglottitis – patient prefers to hold the neck in extension and not flexion
- Pharyngitis (see, eg, streptococcal pharyngitis, viral pharyngitis)
- Peritonsillar abscess
- Airway foreign body
- Esophageal foreign body
- Parapharyngeal abscess
- Lemierre syndrome
- Dental infection
- Meningitis (see, eg, bacterial meningitis, fungal meningitis, viral meningitis)