Retropharyngeal Abscess
What is it?
Polymicrobial abscess in space between posterior pharyngeal wall and prevertebral fascia
Adults: Usually due to direct extension of local infection (ex. ludwig's angina, pharyngitis, dental abscess etc.)
Peds: Usually due to suppurative changes in local lymph nodes from an infection in the head or neck
Can also be caused from trauma- falling with pencil in mouth
Presentation:
Patients may prefer to lay down to prevent abscess from collapsing the airway. If your suspicion is high enough, don't sit these patients up!
Patients will complain most commonly of: sore throat, fever, torticollis, dysphagia
In late stages will develop airway involvement (looks for stritor, change in phonation, drooling, neck stiffness, tripoding, SOB)
Diagnosis:
CT Neck with IV contrast
On CT you will see loss of definition between the anatomic spaces in the neck, stranding in the subcutaneous tissues, tissue enhancement, and frank abscess formation, the location of the findings indicates whether it is a parapharyngeal or retropharyngeal space infection
You can get a soft tissue neck x-ray, but if your suspicion is still high and the x-rays are equivocal, you should still get a CT
MRI is useful for assessing the extent of soft tissue involvement and for delineating vascular complications
Management:
Get Anesthesia/ ENT involved early if there is any degree of upper airway obstruction!
These signs include: neck extension/head in sniffing position, stritor, change in phonation, drooling, neck stiffness, tripoding, SOB, retractions
Coordinate with Anesthesia/ ENT to secure an airway (Tracheostomy in the OR or fiberoptic intubation should be considered)
If there is no airway compromise, consult ENT because many of these patients require I&D/ needle aspiration in the OR
Retropharyngeal abscess <2.5cm without airway compromise can potentially receive a trial of empiric IV abx for 24-48 hours without drainage
Antibiotics (Covering: GAS, Staph aureus, respiratory anaerobes, +/-MRSA) options include: Ampicillin/Sulbactam 3g IV or Clindamycin 600-900mg IV or Cefoxitin 2gm IV
Admit