Retropharyngeal abscess

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Background

  • Polymicrobial abscess in space between posterior pharyngeal wall and prevertebral fascia
  • Adults: Due to direct extension of purulent debris from adjacent site (e.g. Ludwig angina)
    • More likely to extend into the mediastinum
  • Children: Due to suppurative changes within a lymph node (primary infection elsewhere in head or neck)
  • Trauma: Direct inoculation (e.g. child falling with stick in mouth)
Retropharyngeal abscess on CT

Clinical Features

  • Sore throat (76%)
  • Fever (65%)
  • Torticollis (37%)
  • Dysphagia (35%)
  • Late symptoms:
    • Stridor, respiratory distres, chest pain (mediastinitis)
    • Involvement of carotid neurovascular sheath

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections

Noninfectious

Other

Pediatric stridor

<6mo

>6mo

Evaluation

A lateral x-ray demonstrating prevertebral soft tissue swelling (marked by the arrow)
  • CT neck with IV contrast
    • Gold standard
  • XR Soft tissue
    • The prevertebral space should be less than 7mm at C2, 14mm at C6 in children regardless of the age
    • The prevertebral space should be less than 22mm at C6 in adults
    • If the prevertebral space should be less than one-half the width of the corresponding vertebral body
    • If equivocal XR, order CT

Management

  1. Emergent ENT consult
    • Most patients require I&D
    • Indications for drainage - trismus, rim enhancement on CT
  2. Secure airway - care must be taken to minimize contact with abscess as rupture is significant risk
    1. Tracheostomy or fiberoptic intubation may be necessary
    2. CT or MRI may help prepare for method of definitive airway[2]

Antibiotics

Disposition

  • Admit

See Also

References

  1. Melio, Frantz, and Laurel Berge. “Upper Respiratory Tract Infection.” In Rosen’s Emergency Medicine., 8th ed. Vol. 1, n.d.
  2. Mulimani SM. Anesthetic management of tuberculous retropharyngeal abscess in adult. J Anaesthesiol Clin Pharmacol. 2012 Jan-Mar; 28(1): 128–129.