Retropharyngeal abscess


  • 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)
  • Patients may prefer to lay supine to prevent abscess and edematous posterior wall to collapse into airway, so patients should not be forced to sit up
Retropharyngeal abscess on CT

Clinical Features

Initial symptoms

Late symptoms

Differential Diagnosis

Acute Sore Throat

Bacterial infections

Viral infections



Pediatric stridor




A lateral x-ray demonstrating prevertebral soft tissue swelling (marked by the arrow)
  • CT neck with IV contrast
    • Gold standard
  • XR Soft tissue
    • Neck in extension at end inspiration
    • 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
    • The prevertebral space should be less than one-half the width of the corresponding vertebral body
    • If equivocal XR, order CT


  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]



  • Admit

See Also


  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.