Retropharyngeal Abscess

Retropharyngeal Abscess is a topic covered in the Select 5-Minute Pediatrics Topics.

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Basics

Description

A relatively rare but potentially life-threatening infection occurring in the potential space between the posterior pharyngeal wall and prevertebral fascia

Epidemiology

Children <6 years of age are most at risk, with 50% of the cases occurring in those <48 months of age.

Incidence

Most large children’s hospital centers report 1–5 cases per year.

Pathophysiology

  • Most infections result from pharyngitis or supraglottitis and occur because of suppuration of the retropharyngeal lymph nodes, which lie in 2 paramedial chains and drain various nasopharyngeal structures and sinuses.
  • These lymph gland chains disappear in childhood; thus, retropharyngeal abscesses are most common in infancy and early childhood.
  • Cellulitis of the retropharyngeal area leads to formation of a phlegmon, which matures into an abscess.
  • Other sources of infection in this space, often seen in older children and adolescents, include penetrating trauma of the posterior pharynx (e.g., foreign object aspiration, dental procedures, attempts at intubation).
  • Extension of infection into this space can arise from vertebral body osteomyelitis or a dental abscess.

Etiology

  • Infectious: Cultures frequently reveal multiple organisms.
  • The predominant organisms isolated include the following:
    • Streptococcus (group A and others)
    • Staphylococcus aureus
    • Various anaerobic species (e.g., Bacteroides, Peptostreptococcus, Fusobacterium)
  • Many of the isolates are β-lactamase producers.

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