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.
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
- 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
- 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:
What are some Useful Resources for Additional Information?
Centers for Disease Control and Prevention (CDC)
1600 Clifton Rd. Atlanta, GA 30333, USA
Phone: (404) 639-3534
Toll-Free: 800-CDC-INFO (800-232-4636)
TTY: (888) 232-6348
References and Information Sources used for the Article:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001979/ (accessed on 09/10/2014)
http://www.drtbalu.co.in/ret_abs.html (accessed on 09/10/2014)
http://www.nlm.nih.gov/medlineplus/ency/article/000984.htm (accessed on 09/10/2014)
http://www.patient.co.uk/doctor/Retropharyngeal-Abscess.htm (accessed on 09/10/2014)
Helpful Peer-Reviewed Medical Articles:
Dudas, R., & Serwint, J. R. (2006). In brief: retropharyngeal abscess. Pediatr Rev, 27(6), e45-46.
Harkani, A., Hassani, R., Ziad, T., Aderdour, L., Nouri, H., Rochdi, Y., & Raji, A. (2011). Retropharyngeal abscess in adults: five case reports and review of the literature. ScientificWorldJournal, 11, 1623-1629. doi: 10.1100/2011/915163
Hung, M. C., Wu, K. G., Hwang, B., Lee, P. C., & Meng, C. C. (2007). Kawasaki disease resembling a retropharyngeal abscess--case report and literature review. Int J Cardiol, 115(2), e94-96. doi: 10.1016/j.ijcard.2006.08.095
Kakarala, K., Durand, M. L., & Emerick, K. S. (2010). Retropharyngeal abscess in the setting of immune modulation for rheumatoid arthritis. Laryngoscope, 120 Suppl 4, S131. doi: 10.1002/lary.21595
Reilly, B. K., & Reilly, J. S. (2012). Retropharyngeal abscess: diagnosis and treatment update. Infect Disord Drug Targets, 12(4), 291-296.
Al-Sabah, B., Bin Salleen, H., Hagr, A., Choi-Rosen, J., Manoukian, J. J., & Tewfik, T. L. (2004). Retropharyngeal abscess in children: 10-year study. Journal of otolaryngology, 33(6), 352-355.
Dawes, L. C., Bova, R., & Carter, P. (2002). Retropharyngeal abscess in children. ANZ journal of surgery, 72(6), 417-420.
Abdel-Haq, N. M., Harahsheh, A., & Asmar, B. I. (2006). Retropharyngeal abscess in children: the emerging role of group A beta hemolytic streptococcus. Southern medical journal, 99(9), 927-932.