What are the signs and symptoms of a retropharyngeal abscess?

Signs and Symptoms of Retropharyngeal Abscess

Retropharyngeal abscess presents with a constellation of symptoms including fever, neck pain, dysphagia, neck swelling, and torticollis, with potential progression to life-threatening airway obstruction if not promptly diagnosed and treated.

Clinical Presentation

Common Signs and Symptoms

• Fever: Often present and may be high-grade (>39°C)
• Neck pain: Frequently reported and may be severe
• Dysphagia: Difficulty swallowing is a cardinal symptom
• Neck swelling: External swelling may be visible or palpable
• Torticollis: Limited neck movement and abnormal head positioning 1, 2
• Sensation of something stuck in the throat 1

Severity-Based Presentation

1. Low-severity presentation:

   • Mild pain
   • Low-grade fever
   • Minimal neck swelling
   • Preserved swallowing function

2. High-severity presentation:

   • Respiratory distress (present in approximately 29% of children at presentation) 2
   • Hoarseness of voice 3
   • Stridor
   • Drooling (inability to manage secretions)
   • High fever (>39°C)

Age-Specific Considerations

Children

• More common in children under 5 years of age
• Often secondary to upper respiratory infections, particularly oropharyngeal infections 4
• May present with more subtle symptoms in infants
• Can be misdiagnosed as meningitis in some cases 5

Adults

• Less common than in children
• Usually secondary to trauma, foreign body ingestion, or dental infections 4
• Foreign body ingestion accounts for approximately 10% of cases 2

Diagnostic Challenges

Retropharyngeal abscess can be difficult to diagnose due to:

• Variable clinical presentation
• Paucity of physical findings in some cases 5
• Subtle presentation in infants that may mimic other conditions
• Potential for rapid progression to airway compromise

Complications

If not promptly diagnosed and treated, retropharyngeal abscess can lead to:

• Airway obstruction: Most immediate life-threatening complication 3
• Mediastinitis: Infection spreading to the chest cavity
• Pulmonary empyema: Collection of pus in the pleural space
• Spinal canal abscess: Rare but serious complication 4
• Recurrent laryngeal nerve palsy: Can occur in severe cases 2

Warning Signs of Impending Airway Compromise

Clinicians should be vigilant for signs of impending airway obstruction:

• Progressive difficulty breathing
• Stridor
• Increased respiratory rate
• Use of accessory muscles of respiration
• Inability to handle secretions/drooling
• Altered mental status
• Sitting in tripod position (leaning forward with neck extended)

Pitfalls to Avoid

1. Misdiagnosis: Retropharyngeal abscess can be misdiagnosed as meningitis, viral pharyngitis, or simple upper respiratory infection 5
2. Delayed diagnosis: Particularly dangerous in infants where symptoms may be subtle
3. Inadequate airway assessment: Failure to recognize impending airway compromise
4. Incomplete evaluation: Not considering retropharyngeal abscess in patients with neck pain and torticollis 1

Early recognition and prompt treatment of retropharyngeal abscess are essential to prevent potentially fatal complications. Any patient with suspected retropharyngeal abscess should be evaluated in a facility with appropriate medical, surgical, and intensive care capabilities 2.