Please confirm topic selection

Are you sure you want to trigger topic in your Anconeus AI algorithm?

Please confirm action

You are done for today with this topic.

Would you like to start learning session with this topic items scheduled for future?

Updated: Dec 17 2021

Retropharyngeal Abscess

  • Snapshot
    • A 4-year-old boy presents to the emergency department with neck pain and shortness of breath. His mother reports that he has been having difficulty with walking and has been complaining of neck pain 1 day prior to presentation. On physical exam, the patient is in the tripod position, drooling, and is unable to speak or cough. Otolaryngology and anesthesiology are consulted to secure his airway. The patient is urgently brought into the operating room for surgical drainage.
  • Introduction
    • Definition
      • infection of the retropharyngeal space
    • Microbiology
      • Streptococcus pyogenes
      • Staphylococcus aureus
      • respiratory anaerobes
  • Epidemiology
    • Incidence
      • most common in children < 5 years of age
      • in adults, the most common cause is trauma
    • Risk factors
      • recent infection, such as
        • otitis media
        • pharyngitis
        • sinusitis
      • immunosuppression
    • Pathogenesis
      • the retropharyngeal space contains lymph nodes that drain the nasal cavity, paranasal sinuses, nasopharynx, oropharynx, and hypopharynx
        • infections involving these structures can lead to a lymphadenitis, which may progress to the formation of a retropharyngeal abscess
  • Presentation
    • Symptoms/physical exam
      • classic triad
        • stiff neck (e.g., torticollis or an inability to extend the neck)
        • fever
        • odynophagia
      • drooling
  • Imaging
    • CT scan of the neck with contrast
      • indication
        • imaging study of choice in evaluating retropharyngeal abscesses
        • indicated in peritonsillar abscesses in patients > 35 years of age to rule out malignancy
  • Studies
    • Making the diagnosis
      • this is a clinical diagnosis confirmed with radiographic imaging
  • Differential
    • Epiglotitis
      • differentiating factors
        • "thumb sign" on radiography of the neck
    • Ludwig angina
      • infection of submental, submandibular, and sublingual space
      • associated with poor dental hygiene
      • intubate if airway threatened
        • intubate early even if oxygen saturation normal
      • treat with broad spectrum antibiotics + incision and drainage
  • Treatment
    • Medical
      • empiric intravenous antibiotics
        • indication
          • abscess < 2.5 cm2
          • presence of phlegmon
    • Operative
      • surgical drainage
        • indication
          • signs of severe respiratory distress
          • well defined abscess > 2.5 cm2
        • comment
          • antibiotic choice should target S. pyogenes, S. aureus, and respiratory anaerobes
            • e.g., ampicillin-clavulanate and vancomycin
    • Procedural
      • emergent intubation
        • indication
          • in patients with signs of significant airway obstruction
            • "tripod positioning"
            • respiratory distress
            • cyanosis
            • unable to speak or cough
  • Complications
    • Airway obstruction
    • Mediastinitis
    • Internal jugular vein thrombosis
    • Septicemia
1 of 0
1 of 6
Private Note

Attach Treatment Poll
Treatment poll is required to gain more useful feedback from members.
Please enter Question Text
Please enter at least 2 unique options
Please enter at least 2 unique options
Please enter at least 2 unique options