Retropharyngeal abscess
Revision as of 00:17, 16 February 2015 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Retropharyngeal Abscess to 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)
Diagnosis
- 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
Treatment
- Emergent ENT consult
- Most patients require I&D
- Secure airway
Antibiotics
- Clindamycin 600-900mg IV OR
- cefoxitin 2gm IV OR
- Ampicillin/Sulbactam 3g IV
Disposition
- Admit
See Also
Source
- Tintinalli
- emedicine.com
- Emergency Medicine Oral Board Review Illustrated, Okuda