Diagnosis

Retropharyngeal abscess

Etiology

Cause [7ew][uki][7ua]

• Bacterial infection (S viridans, Group A Streptococcus pyogenes, Staphylococcus aureus, Fusobacterium and Haemophilus)

• Penetrating pharyngeal injury

• Dental abscess

• Rare: Expansion from discitis or osteomyelitis

Pathophysiology

1. Upper respiratory tract infection --> suppurative cervical lymphadenitis

2. Infection spreads to the chain of lymph nodes in the retropharyngeal space

3. Enlarging retropharyngeal abscess --> upper airway obstruction

Risk factors [7ew][7ua]

• Children (immature immune system and prominent retropharyngeal lymph nodes)

• Poor oral hygiene

• Immunocompromised states (HIV infection, steroid therapy, chemotherapy)

• Diabetes mellitus

Complications [hz7]

• Airway obstruction

• Rupture of abscess with aspiration

• Acute respiratory distress syndrome

• Sepsis/shock

• Meningoencephalitis

• Cranial nerve palsy

• Bronchial erosion

• Esophageal perforation

• Necrotizing fasciitis

• Spread of infection

  • Mediastinitis, carotid artery erosion and jugular vein thrombosis

Epidemiology

Incidence per 100.000 [gtw][hz7][nyh][vaw][7bs]

Approach

• Nasopharyngolaryngoscopy [uki]

• Blood test: complete blood count, CRP, erythrocyte sedimentation rate

• Blood culture

• Lateral neck radiography

• CT collum

• Chest radiography

• MRI collum

Treatment

1. Non-operative initial treatment: [uki]

   • Fluid resuscitation

   • Oxygen

   • IV Antibiotic treatment [cyh][7ua]

     • Ampicillin-sulbactam (50 mg/kg every 6 hours) or

     • Clindamycin (15 mg/kg every 8 hours)

     • If sepsis or unresponsive to initial antibiotic therapy: Vancomycin or linezolid

2. If suspicion of compromised airways:

   • Intubation along the opposite side of the pharynx [7ew]

   • Surgical or needle cricothyrotomy

   • Tracheostomy

3. Drainage of the abscess:

   • Needle aspiration

   • Intraoral incision for immediate surgical drainage, with or without tonsillectomy

4. If spread to the parapharyngeal space --> External cervical drainage

Differential diagnoses

Acute sinusitis, Angioedema, Bacterial tonsillitis, Brain tumor, Branchial cleft cyst, Cervical cancer, Croup, Dental infection, Dermoid Cyst, Diphtheria, Encephalitis, Epidural hematoma, Epiglottitis, Esophagitis, Foreign body, Hemangioma, Kawasaki disease, Lemierre syndrome, Ludwigs angina, Lymphoma, Mediastinitis, Meningitis, Mononucleosis, Otitis media, Parapharyngeal abscess, Peritonsillar abscess, Pharyngitis, Pneumonia, Rhabdomyosarcoma, Sepsis, Sialadenitis, Thyroglossal duct cyst