Pediatric Retropharyngeal Abscess — Causes and Complications

Image: “Large retropharyngeal abscess.” by James Heilman, MD – Own work. License: CC BY-SA 4.0

Pathophysiology of Pediatric Retropharyngeal Abscess

The retropharyngeal space, as the name suggests, lies behind the pharynx. It is bound anteriorly by the buccopharyngeal fascia, posteriorly by the prevertebral fascia, and laterally by the carotid sheaths. Superiorly, it extends to the base of the skull and inferiorly to the mediastinum.

Epidemiology of Pediatric Retropharyngeal Abscess

A Children’s Hospital of Michigan review showed a 4.5% increase in retropharyngeal abscess cases over the past few years. Similarly, different studies conducted in various United States hospitals indicated increased retropharyngeal abscess cases over time.

Worldwide, the incidence has been increasing, reportedly due to late diagnosis and treatment. It is usually common in children under five years of age, possibly because of poor dental hygiene and dental infections.

Retropharyngeal abscess is more prevalent among males.

Signs and Symptoms of Pediatric Retropharyngeal Abscess

• Stiff neck or torticollis
• Severe pain in the neck
• Malaise
• Fever
• Drooling of saliva
• Enlarged cervical lymph nodes

Causes and Diagnosis of Pediatric Retropharyngeal Abscess

The disease is caused by aerobic and anaerobic organisms. Aerobic organisms include Staphylococcus aureus and beta-hemolytic streptococci. Anaerobic organisms include Bacteroides and Veillonella. Gram-negative organisms include Haemophilus parainfluenzae and Bartonella henselae.

Since the infection is present in deep spaces, a definitive diagnosis is made by a CT scan. A lateral neck radiograph shows the presence of infection in approximately 80% of cases. Retropharyngeal abscess is suspected in cases where the retropharyngeal space is half the size of the second cervical vertebra.

Treatment of Pediatric Retropharyngeal Abscess

Definitive treatment is a surgical incision of the abscess and, ultimately, drainage. The procedure is usually carried out without general anesthesia because intubation can rupture the abscess, leading to aspiration into the lungs.

Some severe cases may require emergency tracheostomy. The disease requires a high dose of intravenous antibiotics. Chronic cases of retropharyngeal abscess usually occur secondary to tuberculosis and require antitubercular therapy.

Complications

• Aspiration of pus contents into the lungs
• Airway obstruction
• Mediastinitis
• Osteomyelitis
• Pericarditis
• Jugular vein thrombosis

Mortality and morbidity

The mortality rate was 1% in a review of neck space infections carried out in Taiwan. With the development of mediastinitis, mortality can reach up to 50% even after antibiotic treatment. A retropharyngeal abscess can also cause jugular vein thrombosis, pericarditis, and carotid artery erosion.