Retropharyngeal Abscess
A retropharyngeal abscess is a collection of pus in the lymph nodes at the back of the throat.
Because the lymph nodes at the back of the throat disappear after childhood, a retropharyngeal abscess almost never occurs in adults. An abscess is usually caused by a bacterial infection that has spread from the tonsils, throat, sinuses, adenoids, nose, or middle ear. Many infections are caused by a combination of bacteria. An injury to the back of the throat from a sharp object, such as a fish bone, occasionally causes a retropharyngeal abscess. Rarely, tuberculosis can also cause a retropharyngeal abscess.
Symptoms and Diagnosis
The main symptoms are pain when swallowing, a fever, and enlargement of the lymph nodes in the neck. The voice is muffled, and the child drools. The abscess can block the airway, causing difficulty in breathing. The child tends to lie on his back, tilt his head and neck back, and raise his chin to make breathing easier.
Complications include bleeding around the abscess, rupture of the abscess into the airway (which can block the airway), and pneumonia. The larynx may go into spasm and further interfere with breathing. Blood clots may form in the jugular veins of the neck. Infection may spread down into the chest.
After observing the symptoms, a doctor orders x-rays and computed tomography (CT) scans of the neck to confirm the diagnosis.
Treatment and Prognosis
Retropharyngeal abscesses often need to be drained, which a doctor does surgically by cutting open the abscess and allowing the pus to drain out. Penicillin plus metronidazole, clindamycin, cefoxitin, or other antibiotics is given, at first intravenously, and then by mouth. Most children do well with prompt treatment.
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