Retropharyngeal Abscess

What are the other Names for this Condition? (Also known as/Synonyms)

• Retropharyngeal Infection with Pus Formation
• RPA (Retropharyngeal Abscess)

What is Retropharyngeal Abscess? (Definition/Background Information)

• Retropharyngeal Abscess (RPA) is a condition characterized by the accumulation of infected material called pus, in the space present at the back of the throat
• It evolves from a superficial infection of the space, which if left untreated, can lead to the formation of an abscess
• The collection of pus may occur due to infection by a microorganism, trauma (objects stuck in the throat), lymph node inflammation, or infected tonsils/adenoids
• RPA can cause severe sore throat, blockage of the airways, swallowing difficulties, respiratory problems, and stiff neck with neck pain
• Early diagnosis and management of Retropharyngeal Abscess is necessary to prevent severe complications from developing in the child or adult
• The prognosis of Retropharyngeal Infection depends upon its severity

There are 2 forms of Retropharyngeal Abscess, which are:

• Acute Retropharyngeal Abscess
• Chronic Retropharyngeal Abscess

Who gets Retropharyngeal Abscess? (Age and Sex Distribution)

• Retropharyngeal Abscess may occur at any age; but, children under the age of 5 years are most susceptible for developing the condition
• This condition may also affect children, under the age of 1 year

What are the Risk Factors for Retropharyngeal Abscess? (Predisposing Factors)

Possible risk factors associated with Retropharyngeal Abscess are:

• The presence of certain infections, such as:
  • Scarlet fever - sore throat with rashes caused by the bacterium Streptococcus pyogenes
  • Measles
  • Tonsillitis - infection and swelling of the tonsils
  • Peritonsillitis - inflammation of the peritonsillar tissues
  • Pharyngitis - inflammation of the throat
  • Otitis media - middle ear infection
• Trauma from foreign bodies, like pieces of bones, and pins
• Age: Children under the age of 5 years have the highest risk of developing Retropharyngeal Abscess

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Retropharyngeal Abscess? (Etiology)

The possible causes of Retropharyngeal Abscess include:

• Upper respiratory tract infection  that causes inflammation of the group of lymph nodes of the neck, leading to RPA
• Acute Retropharyngeal Abscess usually results from formation of pus in the retropharyngeal lymph nodes, due to infected tonsils, adenoid, tooth, or foreign bodies
• Common organisms responsible for the disease include:
  • Beta-hemolytic streptococci
  • Staphylococcus aureus
  • Haemophilus parainfluenzae
  • Anaerobic organisms, like bacteroides Spp
• Chronic Retropharyngeal Abscess may be caused by tuberculosis of the spine

What are the Signs and Symptoms of Retropharyngeal Abscess?

The signs and symptoms of Retropharyngeal Abscess may include:

• Pus accumulation in the space around the tissues, at the back of the throat
• Severe sore throat
• Dysphagia; difficulty in swallowing
• Dribbling of saliva; uncontrollable flow of saliva from the mouth
• Trismus: difficulty in opening the mouth
• Respiratory problems, such as stridor (abnormal breathing sound that is very high-pitched)
• High-grade fever
• Airways obstruction
• Cough
• Agitation
• Neck pain, stiff neck, presence of swelling in the neck
• Malaise, which is general discomfort and uneasiness

How is Retropharyngeal Abscess Diagnosed?

The diagnostic procedure to confirm the presence of Retropharyngeal Abscess may include:

• Physical examination and evaluation of medical history. The physician will examine the throat of the child or adult
• Throat culture: The healthcare provider will gently rub the back of the throat with a cotton swab, to get pus samples that will be sent to the laboratory, to see the growth of specific microorganisms
• Imaging studies, such as CT scan and x-ray of neck; among these, CT scan is a definitive diagnostic exam
• Complete blood count (CBC) shows increased white blood cell count

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Retropharyngeal Abscess?

Retropharyngeal Abscess can cause the following complications:

• Airway obstruction leading to respiratory and breathing troubles
• Aspiration pneumonia: Inflammation/infection of the lungs and airways, caused by breathing in the infectious material
• Mediastinitis: Inflammation of the tissues present in the mid-chest
• Osteomyelitis: Infection of the bone, caused by bacteria and other germs
• Pericarditis: Inflammation of the tissue surrounding the heart
• Epidural abscess: Collection of pus between the covering of the brain and spinal cord and the bones of the skull or spine
• Septicemia, when bacteria enters the bloodstream, resulting in severe infection
• Adult respiratory distress syndrome: Severe infection of the lungs caused by filling-up of fluid in the air sacs, in the lungs
• Wearing away of the 2nd and 3rd cervical vertebrae (present close to the site of infection)
• Deficit of cranial nerves IX and XII
• Septic thrombosis of the jugular vein, a vein which is present in the neck, near the site of infection

How is Retropharyngeal Abscess Treated?

The treatment of Retropharyngeal Abscess may include the following:

• High-dose antibiotics given intravenously is the first line of treatment of treatment against Retropharyngeal Abscess
• Corticosteroids are given to reduce the swelling in the airways
• Care is taken to protect the airway, so that it is not blocked completely
• Drainage of pus is also required through a suitable surgical procedure

How is Retropharyngeal Abscess Prevented?

• The correct diagnosis and immediate treatment of upper respiratory infections can help prevent Retropharyngeal Abscess
• Treating the infections, which can predispose individuals to RPA, can also decrease the risk of development of this condition

What is the Prognosis of Retropharyngeal Abscess? (Outcomes/Resolutions)

• Retropharyngeal Abscess is a life-threatening medical emergency, because of imminent danger of airway obstruction that may be fatal, if early and appropriate treatment is not provided
• The prognosis of Retropharyngeal Abscess depends on the severity of the condition
• A complete recovery is possible, if medical treatment is started immediately
• Care should be taken to avoid a complete blockage of the airways, a condition which could become fatal

Additional and Relevant Useful Information for Retropharyngeal Abscess:

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/health-topics/ent-center/