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Retropharyngeal Abscess

Retropharyngeal Abscess is a topic covered in the 5-Minute Emergency Consult.

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  • 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 fasciitis
    • 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%)


  • 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
    • Mycobacterium tuberculosis
    • Aspergillus and Candida species

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Rosen, Peter, et al., editors. "Retropharyngeal Abscess." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess.
Retropharyngeal Abscess. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess. Accessed April 25, 2019.
Retropharyngeal Abscess. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess
Retropharyngeal Abscess [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Retropharyngeal Abscess ID - 307456 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307456/all/Retropharyngeal_Abscess PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -