eMedicine Specialties > Emergency Medicine > Ear, Nose, & Throat

Retropharyngeal Abscess: Multimedia

Author: Joseph H Kahn, MD, Director of Medical Student Education, Associate Professor, Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine
Contributor Information and Disclosures

Updated: Sep 16, 2009

Multimedia

A 5-year-old boy presented to the ED with 2 days ...
(Enlarge Image)
Media file 1: A 5-year-old boy presented to the ED with 2 days of neck pain and fever but with no sore throat. The child had vomited once, and the mother reported that he was irritable. The child's temperature was 101.7° F, pulse was 118 beats per minute, respirations were 24 per minute, and blood pressure was 122/65 mm Hg. A decreased range of motion of the neck and a right anterior cervical node were observed; the child refused to swallow. Lateral neck radiographic findings show increased retropharyngeal space (white arrow). The CT scan did not demonstrate an abscess. The child was seen by an ear, nose, and throat specialist; he was admitted and started on intravenous clindamycin. He improved for 2-3 days and then worsened. Repeat neck CT scan findings demonstrated a retropharyngeal abscess. Incision and drainage was performed in the operating room. Cultures of the pus grew group A beta-hemolytic streptococci and alpha-streptococci, both sensitive to clindamycin. He improved and was discharged on the tenth hospital day on oral clindamycin.
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A 5-year-old boy presented to the ED with 2 days ...

A 5-year-old boy presented to the ED with 2 days of neck pain and fever but with no sore throat. The child had vomited once, and the mother reported that he was irritable. The child's temperature was 101.7° F, pulse was 118 beats per minute, respirations were 24 per minute, and blood pressure was 122/65 mm Hg. A decreased range of motion of the neck and a right anterior cervical node were observed; the child refused to swallow. Lateral neck radiographic findings show increased retropharyngeal space (white arrow). The CT scan did not demonstrate an abscess. The child was seen by an ear, nose, and throat specialist; he was admitted and started on intravenous clindamycin. He improved for 2-3 days and then worsened. Repeat neck CT scan findings demonstrated a retropharyngeal abscess. Incision and drainage was performed in the operating room. Cultures of the pus grew group A beta-hemolytic streptococci and alpha-streptococci, both sensitive to clindamycin. He improved and was discharged on the tenth hospital day on oral clindamycin.

An 8-month-old infant boy presented with fever an...
(Enlarge Image)
Media file 2: An 8-month-old infant boy presented with fever and a stiff neck. According to the mother, the baby was not moving his neck as much as usual. The mother also reported decreased oral intake. His temperature was 100° F, pulse was 104 beats per minute, respirations were 48 per minute, oxygen saturation was 98% (room air [RA]). The left tympanic membrane (TM) was inflamed and nonmobile. Left submandibular and left postauricular nodes were noted. The lateral neck radiograph shows increased retropharyngeal space. The CT scan demonstrated a small retropharyngeal abscess. The WBC count was 26,000 (24 polymorphonuclear leukocytes [P], 5 bands [B], 63 lymphocytes [L], 8 monocytes [M]). The baby was examined by an ear, nose, and throat specialist; he was admitted and started on intravenous clindamycin. He improved over the next few days and was discharged on the fifth hospital day on oral clindamycin with a plan for repeat CT scans of the neck on an outpatient basis.
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An 8-month-old infant boy presented with fever an...

An 8-month-old infant boy presented with fever and a stiff neck. According to the mother, the baby was not moving his neck as much as usual. The mother also reported decreased oral intake. His temperature was 100° F, pulse was 104 beats per minute, respirations were 48 per minute, oxygen saturation was 98% (room air [RA]). The left tympanic membrane (TM) was inflamed and nonmobile. Left submandibular and left postauricular nodes were noted. The lateral neck radiograph shows increased retropharyngeal space. The CT scan demonstrated a small retropharyngeal abscess. The WBC count was 26,000 (24 polymorphonuclear leukocytes [P], 5 bands [B], 63 lymphocytes [L], 8 monocytes [M]). The baby was examined by an ear, nose, and throat specialist; he was admitted and started on intravenous clindamycin. He improved over the next few days and was discharged on the fifth hospital day on oral clindamycin with a plan for repeat CT scans of the neck on an outpatient basis.

More on Retropharyngeal Abscess

Overview: Retropharyngeal Abscess
Differential Diagnoses & Workup: Retropharyngeal Abscess
Treatment & Medication: Retropharyngeal Abscess
Follow-up: Retropharyngeal Abscess
Multimedia: Retropharyngeal Abscess
References
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References

  1. Abdel-Haq NM, Harahsheh A, Asmar BL. Retropharyngeal abscess in children: the emerging role of group A beta hemolytic streptococcus. South Med J. Sep 2006;99(9):927-31. [Medline].

  2. Lander L, Lu S, Shah RK. Pediatric retropharyngeal abscesses: a national perspective. Int J Pediatr Otorhinolaryngol. Dec 2008;72(12):1837-43. [Medline].

  3. Page NC, Bauer EM, Lieu JE. Clinical features and treatment of retropharyngeal abscess in children. Otolaryngol Head Neck Surg. Mar 2008;138(3):300-6. [Medline].

  4. Wang LF, Kuo WR, Tsai SM, Huang KJ. Characterizations of life-threatening deep cervical space infections: a review of one hundred ninety-six cases. Am J Otolaryngol. Mar-Apr 2003;24(2):111-7. [Medline].

  5. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg. Nov 2005;133(5):709-14. [Medline].

  6. Coticchia JM, Getnick GS, Yun RD, Arnold JE. Age-, site-, and time-specific differences in pediatric deep neck abscesses. Arch Otolaryngol Head Neck Surg. Feb 2004;130(2):201-7. [Medline].

  7. Nwaorgu OG, Onakoya PA, Fasunla JA, Ibekwe TS. Retropharyngeal abscess: a clinical experience at the University College Hospital Ibadan. Niger J Med. Oct-Dec 2005;14(4):415-8. [Medline].

  8. Craig FW, Schunk JE. Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management. Pediatrics. Jun 2003;111(6 Pt 1):1394-8. [Medline].

  9. Ridder GJ, Technau-Ihling K, Sander A, Boedeker CC. Spectrum and management of deep neck space infections: an 8-year experience of 234 cases. Otolaryngol Head Neck Surg. Nov 2005;133(5):709-14. [Medline].

  10. Kamath MP, Bhojwani KM, Kamath SU, Mahabala C, Agarwal S. Tuberculous retropharyngeal abscess. Ear Nose Throat J. Apr 2007;86(4):236-7. [Medline].

  11. Carinci F, Polito J, Patore A. Pharyngeal actinomycosis: a case report. Gerodontology. June 2007;24:121-123. [Medline].

  12. Fleisch AF, Nolan S, Gerber J, Coffin SE. Methicillin-resistant Staphylococcus aureus as a cause of extensive retropharyngeal abscess in two infants. Pediatr Infect Dis J. Dec 2007;26(12):1161-3. [Medline].

  13. Elliott M, Yong S, Beckenham T. Carotid artery occlusion in association with a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol. Feb 2006;70(2):359-63. [Medline].

  14. Oh JH, Kim Y, Kim CH. Parapharyngeal abscess: comprehensive management protocol. ORL J Otorhinolaryngol Relat Spec. 2007;69(1):37-42. [Medline].

  15. Courtney MJ, Mahadevan M, Miteff A. Management of paediatric retropharyngeal infections: non-surgical versus surgical. ANZ J Surg. Nov 2007;77(11):985-7. [Medline].

  16. Sanford JP, Gilbert DN, Moellering RC Jr. Parapharyngeal space infection. In: The Sanford Guide to Antimicrobial Therapy. 38th ed. 2008.

  17. Elliott M, Yong S, Beckenham T. Carotid artery occlusion in association with a retropharyngeal abscess. Int J Pediatr Otorhinolaryngol. Feb 2006;70(2):359-63. [Medline].

  18. Agada FO, Sharma R, Makura ZG. Atypical presentation of cutaneous tuberculosis and a retropharyngeal neck abscess. Ear Nose Throat J. Jan 2006;85(1):60-2. [Medline].

  19. Bank DE, Krug SE. New approaches to upper airway disease. Emerg Med Clin North Am. May 1995;13(2):473-87. [Medline].

  20. Beasley DJ, Amedee RG. Deep neck space infections. J La State Med Soc. May 1995;147(5):181-4. [Medline].

  21. Daya H, Lo S, Papsin BC, Zachariasova A, Murray H, Pirie J, et al. Retropharyngeal and parapharyngeal infections in children: the Toronto experience. Int J Pediatr Otorhinolaryngol. Jan 2005;69(1):81-6. [Medline].

  22. Fogeltanz KA, Pursel KJ. Retropharyngeal abscess presenting as benign neck pain. Journal of Manipulative & Physiological Therapeutics. February 2006;29:174-8. [Medline].

  23. Gaglani MJ, Edwards MS. Clinical indicators of childhood retropharyngeal abscess. Am J Emerg Med. May 1995;13(3):333-6. [Medline].

  24. Har-El G, Aroesty JH, Shaha A, Lucente FE. Changing trends in deep neck abscess. A retrospective study of 110 patients. Oral Surg Oral Med Oral Pathol. May 1994;77(5):446-50. [Medline].

  25. Hughes J, Martin RJ, Clutterbuck EJ. Retropharyngeal infection with Staphylococcus aureus in a haemodialysis patient. Am J Nephrol. 1993;13(6):435-6. [Medline].

  26. Kelly CP, Isaacman DJ. Group B streptococcal retropharyngeal cellulitis in a young infant: a case report and review of the literature. J Emerg Med. Aug 2002;23(2):179-82. [Medline].

  27. Lazor JB, Cunningham MJ, Eavey RD, Weber AL. Comparison of computed tomography and surgical findings in deep neck infections. Otolaryngol Head Neck Surg. Dec 1994;111(6):746-50. [Medline].

  28. Philpott CM, Selvadurai D, Banerjee AR. Paediatric retropharyngeal abscess. J Laryngol Otol. Dec 2004;118(12):919-26. [Medline].

  29. Pontell J, Har-El G, Lucente FE. Retropharyngeal abscess: clinical review. Ear Nose Throat J. Oct 1995;74(10):701-4. [Medline].

  30. Pynn BR, Sands T, Pharoah MJ. Odontogenic infections: Part one. Anatomy and radiology. Oral Health. May 1995;85(5):7-10, 13-4, 17-8 passim. [Medline].

  31. Sato K, Izumi T, Toshima M, Nagai T, Muroi K, Komatsu N, et al. Retropharyngeal abscess due to methicillin-resistant Staphylococcus aureus in a case of acute myeloid leukemia. Intern Med. Apr 2005;44(4):346-9. [Medline].

  32. Schroeder LL, Knapp JF. Recognition and emergency management of infectious causes of upper airway obstruction in children. Semin Respir Infect. Mar 1995;10(1):21-30. [Medline].

  33. Sethi DS, Stanley RE. Deep neck abscesses--changing trends. J Laryngol Otol. Feb 1994;108(2):138-43. [Medline].

  34. Shefelbine SE, Mancuso AA, Gajewski BJ, Ojiri H, Stringer S, Sedwick JD. Pediatric retropharyngeal lymphadenitis: differentiation from retropharyngeal abscess and treatment implications. Otolaryngol Head Neck Surg. Feb 2007;136(2):182-8. [Medline].

  35. Simsek S, Yigitkanli K, Kazanci A, Belen D, Bavbek M. Medically treated paravertebral Brucella abscess presenting with acute torticollis: case report. Surg Neurol. Feb 2007;67(2):207-10. [Medline].

  36. Takao M, Ido M, Hamaguchi K, Chikusa H, Namikawa S, Kusagawa M. Descending necrotizing mediastinitis secondary to a retropharyngeal abscess. Eur Respir J. Sep 1994;7(9):1716-8. [Medline].

  37. Tannebaum RD. Adult retropharyngeal abscess: a case report and review of the literature. J Emerg Med. Mar-Apr 1996;14(2):147-58. [Medline].

  38. Ungkanont K, Yellon RF, Weissman JL, Casselbrant ML, Gonzalez-Valdepeña H, Bluestone CD. Head and neck space infections in infants and children. Otolaryngol Head Neck Surg. Mar 1995;112(3):375-82. [Medline].

  39. Vural C, Gungor A, Comerci S. Accuracy of computerized tomography in deep neck infections in the pediatric population. Am J Otolaryngol. May-Jun 2003;24(3):143-8. [Medline].

  40. Watanabe M, Ohshika Y, Aoki T, Takagi K, Tanaka S, Ogata T. Empyema and mediastinitis complicating retropharyngeal abscess. Thorax. Nov 1994;49(11):1179-80. [Medline].

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Further Reading

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Keywords

RPA, retropharyngeal space infection, mediastinitis, Staphylococcus aureus, Bacteroides, Veillonella, Haemophilus parainfluenzae, internal jugular vein thrombosis, carotid artery erosion, pericarditis, epidural abscess, deep cervical space infections, sepsis, airway compromise, upper respiratory infection

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Contributor Information and Disclosures

Author

Joseph H Kahn, MD, Director of Medical Student Education, Associate Professor, Department of Emergency Medicine, Boston Medical Center, Boston University School of Medicine
Joseph H Kahn, MD is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, Physicians for Social Responsibility, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Michael Glick, DMD, Professor and Acting Chair, Department of Diagnostic Sciences, New Jersey Dental School, University of Medicine and Dentistry of New Jersey
Michael Glick, DMD is a member of the following medical societies: American Academy of Oral Medicine and American Dental Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Mark W Fourre, MD, Program Director, Department of Emergency Medicine, Maine Medical Center; Associate Clinical Professor, Department of Surgery, University of Vermont School of Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Robert E O'Connor, MD, MPH, Professor and Chair, Department of Emergency Medicine, University of Virginia Health System
Robert E O'Connor, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Heart Association, American Medical Association, Medical Society of Delaware, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

 
 
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