Retropharyngeal Abscess
Basics
Description
Description
- Deep tissue infection of the retropharyngeal space:
- Potential space bound anteriorly by buccopharyngeal fascia, posteriorly by alar fascia, superiorly by skull base, inferiorly by fusion of fascial layers at T2
- Space fused by raphe at midline with chains of lymph nodes extending down each side
- Alar fascia is poor barrier and allows retropharyngeal infections to spread into “danger” space and posterior mediastinum
- Primarily a disease of children, but increasing frequency in adults:
- Peak incidence at 3–5 yr when retropharyngeal nodes most prominent
- Prognosis is good when promptly diagnosed and aggressively managed with IV antibiotics and/or surgical drainage
- Complications due to mass effect, rupture, or spread are the major source of morbidity and include:
- Airway compromise (most common)
- Aspiration pneumonia due to rupture
- Sepsis
- Spontaneous perforation
- Necrotizing soft tissue infection
- Mediastinitis
- Thrombosis of the internal jugular vein
- Jugular vein suppurative thrombophlebitis (Lemierre syndrome)
- Erosion into carotid artery (primarily adults)
- Atlantoaxial dislocation from erosion of ligaments
- Cranial nerve palsies (typically IX–XII)
- Epidural abscess
- Recurrent abscess formation (1–5%)
Etiology
Etiology
- Causes:
- Most often arises from infection of nasopharynx, paranasal sinuses, or middle ear
- Infection then spreads to lymph nodes between posterior pharyngeal wall and alar fascia
- Trauma, foreign bodies, and iatrogenic introduction of infection from instrumentation also common cause, especially in adults
- Diabetes and other immunosuppressed states may predispose to this infection
- Bacteriology: Predominately polymicrobial with anaerobes and aerobes
- Most common organisms are:
- Streptococcus pyogenes and Streptococcus viridans
- Staphylococcus aureus (including MRSA)
- Respiratory anaerobes (including Prevotella, Fusobacterium, and Veillonella)
- Less common organisms are:
- Haemophilus species
- Acid-fast bacilli
- Klebsiella pneumoniae
- Escherichia coli
- Eikenella corrodens
- Mycobacterium tuberculosis
- Aspergillus and Candida species
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Citation
Schaider, Jeffrey J., et al., editors. "Retropharyngeal Abscess." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess.
Retropharyngeal Abscess. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess. Accessed October 9, 2024.
Retropharyngeal Abscess. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess
Retropharyngeal Abscess [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 October 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess.
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