Introduction to retropharyngeal abscess

Retropharyngeal abscess is an uncommon but potentially life-threatening condition. Symptoms of retropharyngeal abscess may initially mimic pharyngitis but, as inflammation increases, pain, trismus, respiratory distress and airway obstruction can develop.

Retropharyngeal abscesses are most common in children younger than 5 years and are typically a complication of infection in the oropharynx, middle ear, prevertebral space, nasal cavity or nasopharynx, which all drain to the lymph nodes in the retropharyngeal space. As children become older, the lymph nodes in the retropharyngeal space tend to involute and abscesses are less commonEsposito 2022.

Retropharyngeal abscess can also result from local trauma from a procedure or ingestion of a foreign body, particularly in adults. Spontaneous infection can also occur, especially in children. If infection spreads to the lymph nodes in the retropharyngeal space, cellulitis, phlegmon, suppuration and abscess formation can occur. The abscess may be localised or extend inferiorly into the posterior mediastinum and prevertebral space. For management of infection extending into the mediastinum, see Mediastinitis.

Retropharyngeal abscess is usually a polymicrobial infection; implicated organisms include Streptococcus pyogenes (group A streptococcus), Staphylococcus aureus and anaerobes (eg Prevotella, Peptostreptococcus and Fusobacterium species).