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Retropharyngeal Abscess

By Clarence T. Sasaki, MD, The Charles W. Ohse Professor of Surgery and Director, Yale Larynx Lab, Yale University School of Medicine

A retropharyngeal abscess is a collection of pus in the lymph nodes at the back of the throat.

  • A retropharyngeal abscess is caused by a bacterial infection.

  • Symptoms include difficulty and pain when swallowing, a fever, stiff neck, and noisy breathing.

  • The diagnosis is based on symptoms and x-rays or computed tomography of the neck.

  • Children who receive prompt treatment do well.

  • The abscess is drained surgically, and antibiotics are given to eliminate the infection.

Because the lymph nodes at the back of the throat begin to disappear by age 4 to 5 years, retropharyngeal abscesses are more common among children aged 1 to 8 than adults.

A retropharyngeal abscess is usually caused by a bacterial infection that has spread from the tonsils, throat, sinuses, adenoids, or nose. Many infections are caused by a combination of bacteria. HIV infection and tuberculosis are becoming more common causes in adults and children. An injury to the back of the throat caused by a sharp object, such as a fish bone, occasionally causes a retropharyngeal abscess.


The main symptoms are difficulty and pain when swallowing, a fever, and enlargement of the lymph nodes in the neck. The voice is muffled, and children may drool. The neck may be stiff, and children may hold their head at an angle.

The abscess can block the airway, making breathing difficult and noisy, particularly when children inhale (called stridor). Children may lie on their back, tilt their head and neck back, and raise their chin to make breathing easier. Adults may have severe neck pain but do not always have stridor.

Complications include bleeding around the abscess, rupture of the abscess into the airway (which can block the airway), and pneumonia. The voice box (larynx) may go into spasm and further interfere with breathing. Blood clots may form in the jugular veins of the neck. Infection may spread down into the chest. Sometimes widespread inflammation and infection of the bloodstream occurs, causing organs to malfunction (a condition called septic shock).


  • X-rays and computed tomography

A doctor suspects the disorder in children who have a severe, unexplained sore throat, a stiff neck, and noisy breathing.

X-rays and computed tomography (CT) scans of the neck can confirm the diagnosis.


  • Antibiotics

  • A breathing tube followed by surgery to drain the abscess

Most children do well with prompt treatment. Retropharyngeal abscesses often need to be drained surgically.

First, people are given antibiotics such as ceftriaxone or clindamycin by vein.

For both children and adults, doctors insert a plastic breathing tube through the mouth into the windpipe (trachea) to keep the airway open. Doctors then cut the abscess open allowing the pus to drain out.