Retropharyngeal Abscess – Look for limited neck mobility.
Happy Holidays to All!! What better way to celebrate the Holidays than to consider purulent infections in a small space of the neck!
Retropharyngeal abscesses typically occur in children <5 yrs of age (as the retropharyngeal lymph tissue atrophy after this time). They can also occur after direct trauma (from a popsicle stick or other foreign objects impaling the adjacent structures) in older kids and “big babies” (AKA adults).
- As often occurs, the classic teaching is not the common finding.
- You may have been taught that retropharyngeal abscesses present with signs of respiratory distress (stridor, tachypnea, drooling)… and this can occur; however, if you wait for the purulent puss pocket to cause such symptoms it has grown large enough to encroach upon the airway. It would be beneficial for all involved to pick up on the diagnosis earlier.
- Look for neck stiffness or limited range of motion of the neck.
- Limited ROM of the neck may present as dramatically as torticollis or more subtly as the patient refusing to look in a direction.
- In kids who complain of sore throat, it is important to document whether their necks are supple and have full range of motion (it demonstrate to the “world” that you have considered the potential for retropharyngeal abscess).
- If you suspect the diagnosis, plain films can be obtained… but don’t completely rule-out the disease (likely to be used in those patients in whom you have a lower suspicion for the entity). CT of the neck is the modality of choice to investigate and define the extent of the condition in most patients.
- If present, the microbes involved are a mixture of anaerobic and aerobic bacteria… so Clindamycin is generally the 1st line agent, with Cefazolin being 2nd choice.
- Surgical drainage may not be required… especially in those that are diagnosed early on and started on antibiotics. So looking for neck ROM as an early sign of retropharyngeal abscess may just save the kid a surgery!!
Gibson, CA. “Do not rely on the presence of respiratory compromise to make the diagnosis of retropharyngeal abscess.” In Avoiding Common Errors in the Emergency Department. Ed: Mattu A, Chanmugam AS, Swadron SP, Tibbles CD, Woolridge DP. 2010; pp. 212-214.