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 and 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 disappear after childhood, retropharyngeal abscesses are more common among children than among adults. An abscess is usually caused by a bacterial infection that has spread from the tonsils, throat, sinuses, adenoids, nose, or middle ear. Many infections are caused by a combination of bacteria. An injury to the back of the throat from a sharp object, such as a fish bone, occasionally causes a retropharyngeal abscess.

Symptoms and Diagnosis

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.

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).

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.

Treatment

Most children do well with prompt treatment. Retropharyngeal abscesses often need to be drained surgically. A doctor cuts the abscess open allowing the pus to drain out. Penicillin plus metronidazole, clindamycin, ampicillin-sulbactam, cefoxitin, or other antibiotics are given, at first by vein and then by mouth.

Last full review/revision June 2006 by Geoffrey A. Weinberg, MD