Retropharyngeal abscess
Encyclopedia
Most commonly seen in infants and young children, retropharyngeal abscess (RPA) is an abscess
located in the tissues in the back of the throat behind the posterior pharyngeal wall (the retropharyngeal space
). Because RPA's typically occur in deep tissue, they are difficult to diagnose by physical examination
alone. RPA is a relatively uncommon illness, and therefore may not receive early diagnosis in children presenting with stiff neck
, malaise
, difficulty swallowing, or other symptoms listed below. Early diagnosis is key, while a delay in diagnosis and treatment may lead to death. RPA's can also occur in adults of any age.
RPA can lead to airway obstruction
or sepsis
- both life-threatening emergencies. Fatalities normally occur from patients not receiving treatment immediately and suffocating prior to knowing that anything serious was wrong.
, tonsil
s, sinuses
, adenoid
s or middle ear
. Any Upper Respiratory Infection (URI
) can be a cause. RPA can also result from a direct infection due to penetrating injury or a foreign body
.
(limited neck mobility or torticollis
), some form of palpable neck pain (may be in "front of the neck" or around the Adam's Apple
), malaise
, difficulty swallowing, fever
, stridor
, drooling, or enlarged cervical lymph node
s. Any combination of these symptoms should arouse suspicion of RPA.
approach is typically used to access/drain the abscess, and the outcome is usually positive. In complex cases, tracheotomy
may be required to prevent upper airway obstruction caused by edema in the neck.
High dose of Intravenous antibiotics are required in order to control the infection and reduce the size of the abscess prior to surgery.
X ray of the neck 80% of the time shows swelling of the retropharyngeal space. If the retropharyngeal space
is more than half of the size of the C2 vertebra, it may indicate retropharyngeal abscess.
Abscess
An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...
located in the tissues in the back of the throat behind the posterior pharyngeal wall (the retropharyngeal space
Retropharyngeal space
The retropharyngeal space is a space bounded by the buccopharyngeal fascia anteriorly and the alar fascia posteriorly.It includes the retropharyngeal lymph nodes....
). Because RPA's typically occur in deep tissue, they are difficult to diagnose by physical examination
Physical examination
Physical examination or clinical examination is the process by which a doctor investigates the body of a patient for signs of disease. It generally follows the taking of the medical history — an account of the symptoms as experienced by the patient...
alone. RPA is a relatively uncommon illness, and therefore may not receive early diagnosis in children presenting with stiff neck
Stiff neck
Stiff neck refers to an instance when one experiences discomfort or pain when trying to turn or move the neck. The muscle that is most commonly involved in cases of stiff neck is the levator scapulae....
, malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
, difficulty swallowing, or other symptoms listed below. Early diagnosis is key, while a delay in diagnosis and treatment may lead to death. RPA's can also occur in adults of any age.
RPA can lead to airway obstruction
Airway obstruction
Airway obstruction is a respiratory problem caused by increased resistance in the bronchioles that reduces the amount of air inhaled in each breath and the oxygen that reaches the pulmonary arteries...
or sepsis
Sepsis
Sepsis is a potentially deadly medical condition that is characterized by a whole-body inflammatory state and the presence of a known or suspected infection. The body may develop this inflammatory response by the immune system to microbes in the blood, urine, lungs, skin, or other tissues...
- both life-threatening emergencies. Fatalities normally occur from patients not receiving treatment immediately and suffocating prior to knowing that anything serious was wrong.
Causes
RPA is usually caused by a bacterial infection originating from the nasopharynxNasopharynx
The nasopharynx is the uppermost part of the pharynx. It extends from the base of the skull to the upper surface of the soft palate; it differs from the oral and laryngeal parts of the pharynx in that its cavity always remains patent .-Lateral:On its lateral wall is the pharyngeal ostium of the...
, tonsil
Tonsil
Palatine tonsils, occasionally called the faucial tonsils, are the tonsils that can be seen on the left and right sides at the back of the throat....
s, sinuses
Sinus (anatomy)
Sinus is Latin for "bay", "pocket", "curve", or "bosom". In anatomy, the term is used in various contexts.A sinus is a sack or cavity in any organ or tissue, or an abnormal cavity or passage caused by the destruction of tissue...
, adenoid
Adenoid
Adenoids are a mass of lymphoid tissue situated posterior to the nasal cavity, in the roof of the nasopharynx, where the nose blends into the throat....
s or middle ear
Middle ear
The middle ear is the portion of the ear internal to the eardrum, and external to the oval window of the cochlea. The mammalian middle ear contains three ossicles, which couple vibration of the eardrum into waves in the fluid and membranes of the inner ear. The hollow space of the middle ear has...
. Any Upper Respiratory Infection (URI
Úri
Úriis a village and commune in the comitatus of Pest in Hungary....
) can be a cause. RPA can also result from a direct infection due to penetrating injury or a foreign body
Foreign body
A foreign body is any object originating outside the body. In machinery, it can mean any unwanted intruding object.Most references to foreign bodies involve propulsion through natural orifices into hollow organs....
.
Symptoms
Symptoms may include stiff neckStiff neck
Stiff neck refers to an instance when one experiences discomfort or pain when trying to turn or move the neck. The muscle that is most commonly involved in cases of stiff neck is the levator scapulae....
(limited neck mobility or torticollis
Torticollis
Torticollis, or wryneck, is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature...
), some form of palpable neck pain (may be in "front of the neck" or around the Adam's Apple
Adam's apple
The laryngeal prominence—commonly known as the Adam's Apple—is a feature of the human neck. This lump, or protrusion, is formed by the angle of the thyroid cartilage surrounding the larynx...
), malaise
Malaise
Malaise is a feeling of general discomfort or uneasiness, of being "out of sorts", often the first indication of an infection or other disease. Malaise is often defined in medicinal research as a "general feeling of being unwell"...
, difficulty swallowing, fever
Fever
Fever is a common medical sign characterized by an elevation of temperature above the normal range of due to an increase in the body temperature regulatory set-point. This increase in set-point triggers increased muscle tone and shivering.As a person's temperature increases, there is, in...
, stridor
Stridor
Stridor is a high pitched wheezing sound resulting from turbulent air flow in the upper airway. Stridor is a physical sign which is produced by narrow or obstructed airway path. It can be inspiratory, expiratory or biphasic . Inspiratory stridor is common...
, drooling, or enlarged cervical lymph node
Lymph node
A lymph node is a small ball or an oval-shaped organ of the immune system, distributed widely throughout the body including the armpit and stomach/gut and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immune cells. Lymph nodes are found all through the body, and act as...
s. Any combination of these symptoms should arouse suspicion of RPA.
Treatment
RPA's frequently require surgical intervention. A tonsillectomyTonsillectomy
A tonsillectomy is a 3,000-year-old surgical procedure in which the tonsils are removed from either side of the throat. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea, nasal airway obstruction, snoring, or...
approach is typically used to access/drain the abscess, and the outcome is usually positive. In complex cases, tracheotomy
Tracheotomy
Among the oldest described surgical procedures, tracheotomy consists of making an incision on the anterior aspect of the neck and opening a direct airway through an incision in the trachea...
may be required to prevent upper airway obstruction caused by edema in the neck.
High dose of Intravenous antibiotics are required in order to control the infection and reduce the size of the abscess prior to surgery.
Diagnosis
CT is the definitive diagnostic test.X ray of the neck 80% of the time shows swelling of the retropharyngeal space. If the retropharyngeal space
Retropharyngeal space
The retropharyngeal space is a space bounded by the buccopharyngeal fascia anteriorly and the alar fascia posteriorly.It includes the retropharyngeal lymph nodes....
is more than half of the size of the C2 vertebra, it may indicate retropharyngeal abscess.