Retropharyngeal Abscess : Symptoms, Causes, Diagnosis, Complications and Treatment

Retropharyngeal abscess is a collection of pus in the back of the throat. As lymph nodes are present in the back of the throat these get swollen and irritated during infection. It typically occurs in children from 2-4 years of age and it causes suppuration of the lymph nodes. Retropharyngeal space is the space between buccopharyngeal fascia anteriorly and prevertebral fascia posteriorly. There are two RPS on both sides but these do not communicate. The infection of the space is dangerous because it can extend superiorly from the base of the skull and inferiorly to the level of T4.

Retropharyngeal Abscess Symptoms

 Retropharyngeal abscesses are typically present in the children after an upper respiratory infection in the children with symptoms like

• Sore throat 

• Fever 
• Further progression to odynophagia and dysphagia
• Drooling
• Neck stiffness
• Stridor
• Torticollis and difficulty of neck extension are most common features.
• Trismus
• Hot potato voice is a typical feature

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Retropharyngeal Abscess Causes

• The RPS consists of Node of Rouvier which drains the tonsil and adenoid. The Retropharyngeal abscess occurs due to acute suppurative lymphangitis of lymph nodes of Rouvier.

• Retropharyngeal abscesses are typically present in the children after a pre-existing upper respiratory infection in the children. 
• These can be due to direct spread of bacterial infection from the pharyngitis, tonsillitis, otitis media or sinusitis.
• There are some cases seen in which it can also occur due to spread of acute osteomyelitis of the cervical spine.
• The abscess is mainly polymicrobial and the main bacteria involved are Staph aureus, Strep pyogenes and many anerobic organisms.
• It can also occur in adults and that is mainly due to posterior pharyngeal wall injury which is most likely fish bone injury.
• The risk of RPA decreases after 6 years of age due to fewer viral Upper respiratory tract Infection and regression of Nodes of Rouvier.

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Retropharyngeal Abscess Diagnosis

The main resource for the diagnosis of retropharyngeal abscess is Xray. CT scan can be done if there is no respiratory compromise. On Xray, it is difficult to differentiate it from other pharyngeal abcsesses like pre-vertebral abscess.

• On Xray , Pre- vertebral space widening will be seen. The shadow of prevertebral space will be two times more than the size of the vertebrae.
• Straightening of the cervical spine is seen.
• Air bubbles may be present.

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Retropharyngeal Abscess Differential Diagnosis

1. Prevertebral abcsess 

• More common in adults whereas Retro pharyngeal abcsess is more common in children.
• Prevertebral space is a single midline space where as RPS is a paired space.
• It begins from the base of the skull and inferiorly it can extends to the coccyx.
• RPA presents as a bulge lateral to the midline whereas prevertebral abscess is a midline bulge.
• The most common cause of infection in PVA is TB infection secondary to POT’s spine.

2. Peritonsillar abcsess (Quinsy)

• In Quinsy there will be no neck swelling visible and it mainly affects children above 10 years of age.
• There will be a uvula deviation to the opposite side.

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Retropharyngeal Abscess Complications

• Airway compromise
• Bacteria can spread into the blood causing Bacteremia.
• Carotid artery rupture
• Jugular Venous thrombosis
• Acute necrotizing mediastinitis- The infection can get transmitted to the posterior mediastinum causing chest pain, dyspnea, odynophagia etc. This requires surgical intervention.

Retropharyngeal Abscess Treatment

• If there is respiratory compromise then there is an urgent need of Endotracheal Intubation. If Endotracheal Intubation is not possible then tracheostomy should be done.
• IV antibiotics
• Surgical drainage.

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