View source for Retropharyngeal abscess

==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)

==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==
{{Sore throat DDX}}

==Diagnostic Evaluation==
*CT neck w/ 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==
#Emergent ENT consult
#*Most patients require I&D
#*Indications for drainage - trismus, rim enhancement on CT
#Secure airway
===[[Antibiotics]]===
*[[Clindamycin]] 600-900mg IV OR 
*[[cefoxitin]] 2gm IV OR
*[[Ampicillin/Sulbactam]] 3g IV

==Disposition==
*Admit

==See Also==
*[[PTA]]
*[[Ludwig's Angina]]
*[[Pharyngitis]]

==References==
<References/>

[[Category:ENT]]
[[Category:ID]]