Retropharyngeal Abscess

Definition of Retropharyngeal Abscess

A retropharyngeal abscess or RPA is a deep infection of a neck tissue. It means that there is pus inside the tissue at the back of the throat, adjacent to the vertebrae. This kind of abscess occurs more in children under five years old, although it is also possible that it may occur at any age. A retropharyngeal abscess is severe and sometimes the infection is also life-threatening due to its anatomic location and if the passage of air to the lungs is obstructed.

Source – epainassist.com

The retropharyngeal space is located at anterior region of the prevertebral fascia and to the posterior region of the esophageal wall. The lymph nodes in this space drain the middle ear, nasopharynx, and paranasal sinuses. Most of the time, infections in those areas will also result to an infection in the retropharyngeal space. The atrophying process of these lymph nodes before or at puberty had been generally recognized and accepted as a simplification of the prevalence of retropharyngeal abscess in young children. As a matter of fact, a few individuals are convinced that they atrophy after the child reaches 4 years of age.

Causes of Retropharyngeal Abscess

Retropharyngeal abscess may be result from an upper respiratory tract infection that causes an inflammation in the retropharyngeal nodes, which will then lead to the formation of pus and develop into an abscess. There is a median raphe of the buccopharyngeal fascia which is why the abscess is only limited on one part of the midline.

RPA can be classified as:

Acute retropharyngeal abscess

It is caused by the festering of retropharyngeal lymph nodes from an infiltrating foreign body, infected tonsil, tooth, or adenoid. This form is more common in children and is frequently caused by:

• Haemophilus parainfluenzae
• Beta-haemolytic streptococci
• Anaerobic organisms such as Bacteroides spp.
• Staphylococcus aureus

Chronic retropharyngeal abscess

It is a rare form, but is often caused by tuberculosis of the spine.

Symptoms of Retropharyngeal Abscess

The signs and symptoms of Retropharyngeal Abscess are related to the inflammation and pressure caused by the abscess on the passage airway or upper respiratory/digestive tract. Immediately contact a physician for any suspected symptoms noted on a child.

These symptoms may include:

• Difficulty swallowing
• Severe sore throat
• Stridor which is a high-pitched wheezing sound during inhalation
• Difficulty breathing
• Spasm of the jaw muscles
• High fever
• Drooling
• Irritability
• Feeling of restlessness or aggravation
• Respiratory distress
• Neck pain
• Coughing
• Feeling of discomfort or uneasiness without any known cause
• Stiff neck
• Smooth bump on one side of the midline

Diagnosis of Retropharyngeal Abscess

The physician will perform the diagnosis through an examination of the throat and an evaluation of the patient’s breathing. Diagnosis is suspected among individuals with unexplained and severe stridor, sore throat, noisy breathing, and neck stiffness. The following tests may also be performed:

Throat culture

It is a type of diagnostic test done in the laboratory and can help evaluate any presence of fungal or bacterial infection inside the throat. A sample is taken from the throat by swabbing the throat and placed in a special cup (culture) that enables the infectious bacteria to grow.

Complete blood count (CBC)

It is a type of blood examination that is used to assess the overall health of the patient and discern a variety of disorders such as leukemia, anemia, and infection. A CBC test can also determine the different features and components of the blood including the carriers of oxygen which are the red blood cells.

Lateral neck X-ray

This test can sometimes be misleading especially in younger children. The test must be taken in the maximum hyperexertion during aspiration that can possibly display a focal widening of the prevertebral soft tissues, erosion of the adjacent vertebral body, or reversal of normal cervical lordosis.

Computed tomography (CT) scan

It is a type of imaging test that can produce images of certain body parts such as the neck. It is the more preferred imaging test since it could also distinguish the differences between cellulitis and retropharyngeal abscess. An entire rim enhancement is an implication of an abscess.

Treatment of Retropharyngeal Abscess

Once the retropharyngeal abscess is identified in the diagnosis, a trial test of antibiotic therapy is initiated. In case the trial does not succeed, surgical drainage of the pus accumulation is the next step in order to prevent airway obstruction. Sometimes when the CT scan is done, it reveals a large hypodense area. Physicians may then select a choice of antibiotic therapy and immediate surgical drainage.

Incision for lateral Drianage of Retropharyngeal abscess

Parenteral dosage forms such as Clindamycin IV or Ampicillin-sulbactam are used to treat retropharyngeal abscess once the patient is afebrile and presenting clinical improvement, following a 14 day regimen of oral antibiotics.

References

1. http://www.healthline.com/health/retropharyngeal-abscess#Overview1
2. https://pedclerk.bsd.uchicago.edu/page/retropharyngeal-abscesses
3. http://patient.info/doctor/retropharyngeal-abscess
4. Wong DK, Brown C, Mills N, Spielmann P, Neeff M (2012 Dec). To drain or not to drain – management of pediatric deep neck abscesses: a case-control study. Int J Pediatr Otorhinolaryngol. 76(12):1810-3.
5. Makeieff M, Pelliccia P, Mondain M, Machi P (2010 Sep). Pseudoaneurysm of the internal carotid artery complicating deep neck space infection. J Pediatr. 157(3):510.
6. Lander L, Lu S, Shah RK (2008 Dec). Pediatric retropharyngeal abscesses: a national perspective. Int J Pediatr Otorhinolaryngol. 72(12):1837-43.