Retropharyngeal abscess

Last reviewed: 9 Nov 2022
Last updated: 18 Oct 2022

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • spiking fever
  • neck pain or torticollis
  • odynophagia
  • dysphagia
  • neck swelling/mass/lymphadenopathy
  • oropharyngeal swelling
  • drooling
More key diagnostic factors

Other diagnostic factors

  • decreased oral intake
  • anorexia
  • malaise
  • irritability
  • trismus
  • dysphonia
  • dyspnoea
  • fatigue
  • sleep apnoea
  • stridor
  • tonsillar swelling
  • increased respiration rate
  • decreased oxygen saturations
  • cyanosis
  • tachypnoea
  • tracheal tug
  • intercostal recession
Other diagnostic factors

Risk factors

  • foreign body ingestion
  • trauma to posterior pharyngeal wall
  • dental caries/infection
  • diabetes mellitus
  • male sex
  • adenotonsillectomy
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC
  • erythrocyte sedimentation rate
  • CT neck with contrast
  • x-ray of neck
  • ultrasonography of neck
  • examination under anaesthetic (EUA)
  • culture
More 1st investigations to order

Treatment algorithm

ACUTE

airway compromise

no airway compromise

Contributors

Authors

Carl Philpott, MB ChB, FRCS (ORL-HNS) DLO, MD, PGCME
Carl Philpott

Consultant in ENT & Rhinology

James Paget University Hospital

Great Yarmouth

UK

Disclosures

CP is an advisory board member for GSK, Sanofi, and Stryker. He has received grants from NIHR and is a trustee of Fifth Sense. CP is an author of a number of references cited in this topic.

Kala Kumaresan, MBBS, MRCS (ENT)

Clinical Research Fellow

Department of ENT

James Paget University Hospital

Norwich

UK

Disclosures

KK declares that she has no competing interests.

Acknowledgements

Professor Carl Philpott and Dr Kala Kumaresan would like to gratefully acknowledge Dr Kristian Hutson, Dr Lorna Langstaff, Dr Asad Qayyum, Dr Kevin Kulendra, Dr Cameron Davies-Husband, and Dr Marcos Martinez Del Pero, previous contributors to this topic.

Disclosures

KH, LL, AQ, KK, CDH, and MMDP declare that they have no competing interests.

Peer reviewers

Remco de Bree, MD, PhD

Otolaryngologist

Head and Neck Surgeon

VU University Medical Center

Amsterdam

The Netherlands

Disclosures

RdB declares that he has no competing interests.

Michael Johns, MD

Director

Assistant Professor

Emory University

Atlanta

GA

Disclosures

MJ declares that he has no competing interests.

Lynn Solomon, MD

Assistant Professor

Tufts University

Boston

MA

Disclosures

LS declares that she has no competing interests.

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