Retropharyngeal Abscess

  • Etiology: pharyngitis or upper respiratory infection -> retropharyngeal adenitis -> abscess, bacterial
  • Imaging: normal prevertebral space is < 1/2 vertebral body at C2, soft tissue thickening of > 1 cervical vertebral body, to diagnose retropharyngeal mass need inspiratory image taken in extension, measurements less important than whether retropharynx changes with respiration
  • DDX: physiological tracheal buckling which can be seen on lateral neck images obtained on expiration + flexion – so beware of false positives due to expiration / flexion – airway radiograph should always be taken in inspiration + extension
  • Complications: airway compression, arteritis, jugular vein occlusion (Lemierre syndrome), extension into mediastinum
  • Clinical: seen in infancy and young children – 6 months to 6 years (older children + adults have peritonsillar + parapharyngeal abscess), 50% cases between 6-12 months, fever / stiff neck / dysphagia / stridor

Cases of Retropharyngeal Abscess

Radiograph of retropharyngeal abscess
Lateral radiograph of the airway taken in inspiration and extension shows massive thickening of the prevertebral soft tissues.