Retropharyngeal Abscess

What is a retropharyngeal abscess?

A retropharyngeal (pronounced “reh-tro-fah-RIN-jee-ul”) abscess is a collection of pus deep in the back of your throat. It results from a bacterial infection affecting your throat’s lymph nodes. As part of your immune system, your lymph nodes help fight infection. They can become swollen and irritated when you have an infection.

A retropharyngeal abscess is a serious condition that requires immediate medical attention. It’s most common in young children, but anyone can develop this abscess.

Who do retropharyngeal abscesses affect?

Retropharyngeal abscesses most commonly affect children between ages 2 and 4. Lymph nodes are larger at this age, making them more susceptible to infection. Lymph nodes in your throat shrink as you age, decreasing your risk of an abscess.

Retropharyngeal abscesses are slightly more common in boys and people assigned male at birth.

How common is a retropharyngeal abscess?

Retropharyngeal abscess is uncommon, but cases have increased in children and adults over the past 20 years. Some studies suggest that the rise is related to increased cases of tonsillitis. Tonsillitis is an infection in your tonsils, the two lumps of tissue in the back of your throat. Another potential reason is the rise in infections involving antibiotic-resistant bacteria called MRSA.

What are the symptoms of a retropharyngeal abscess?

Having trouble swallowing or experiencing pain when you swallow are the most common symptoms of a retropharyngeal abscess. Other symptoms to look for include:

• Severe sore throat.
• Swollen lymph nodes.
• Difficulty breathing.
• Difficulty speaking.
• Noisy breathing.
• Severe headache.
• Stiff neck.
• Coughing.
• Fever.

Children with a retropharyngeal abscess may seem anxious or irritable. They may have so much trouble swallowing that they drool. A child who positions their head oddly (as if to clear their airway) may struggle to get enough air.

See your healthcare provider immediately if you notice any signs of a retropharyngeal abscess.

What are the complications of a retropharyngeal abscess?

A retropharyngeal abscess is serious largely because of its location. Without treatment, a retropharyngeal abscess can eventually block your airway, making breathing difficult. The infection can spread to nearby organs and your blood, causing life-threatening complications. Complications include:

• Blocked airway.
• Aspiration pneumonia.
• Swelling and inflammation in your chest.
• Blood clots in the major veins in your neck (jugular veins).
• Infection that spreads to nearby tissues and organs, like your lungs.
• Infection that spreads to your blood (septic shock).

What causes a retropharyngeal abscess?

A retropharyngeal abscess forms when your lymph nodes get infected. Your lymph nodes swell and eventually break down, forming pus that collects as an abscess in the back of your throat. Causes are different for children and adults.

• Children: Abscesses usually form following an upper respiratory infection (for example, a sinus infection or ear infection). The original infection spreads from the primary site to the lymph nodes in the back of your child's throat, forming an abscess.
• Adults: Abscesses usually form after an injury to the back of your throat. The injury may involve an object puncturing the back of your throat (like a chicken or fish bone). Or the injury may be a complication related to a procedure, like dental work, upper endoscopy or intubation.

Is it viral or bacterial?

Usually, the infection involves multiple types of bacteria. Bacteria that cause retropharyngeal abscesses include:

• Streptococcus pyogenes.
• Staphylococcus aureus (including MRSA).
• Bacteroides.
• Fusobacteria.
• Peptostreptococcus.
• Porphyromonas.
• Prevotella.
• Veillonella.
• Haemophilus influenzae.

How is a retropharyngeal abscess diagnosed?

Your healthcare provider will assess your symptoms and perform a physical exam. An imaging test, like an X-ray or a CT scan, can show the abscess. Your provider may also perform blood tests, including a complete blood count (CBC) and a bacteria culture test. High levels of white blood cells in your CBC indicate an infection. The culture test can show what types of bacteria are causing your infection.

You’ll likely work with a specialist in head and neck conditions called an ear, nose and throat (ENT) specialist during diagnosis and treatment.

How is a retropharyngeal abscess treated?

Retropharyngeal abscess is a serious infection that requires hospitalization. Treatment involves clearing your infection and, in some cases, draining the abscess. Treatments include:

• Antibiotics: You’ll receive broad-spectrum antibiotics intravenously (through a vein) to treat your infection. Broad-spectrum antibiotics kill multiple types of bacteria. You may receive antibiotics designed to treat a specific strain of bacteria if the culture test reveals particular bacteria that are causing your infection.
• Surgery: Your provider will decide whether to drain your abscess based on factors like whether it’s interfering with your breathing. Your provider will insert a breathing tube so you can breathe during the procedure. Then, they’ll cut the abscess open so the pus can escape.

Depending on the extent to which the abscess is blocking your airway, you may need to receive oxygen while in the hospital to help you breathe. You may need to receive fluids through an IV to prevent dehydration if you’re having trouble swallowing.

Once you’re discharged from the hospital, you’ll need to continue taking antibiotics by mouth to ensure the infection’s gone and doesn’t return.

What medications are used?

Antibiotics used to treat retropharyngeal abscesses include:

• Ampicillin sulbactam.
• Clindamycin.
• Vancomycin.
• Linezolid.
• Amoxicillin-clavulanate.

How can I prevent a retropharyngeal abscess?

Don’t delay seeking treatment if your child is sick, especially if they have an upper respiratory infection.

You can prevent complications from a retropharyngeal abscess by taking symptoms seriously. If you’re noticing signs of a retropharyngeal abscess — in either yourself or your child — see your healthcare provider immediately.

What can I expect if I have a retropharyngeal abscess?

The outlook is excellent with treatment. Treating the infection and draining the pus can cure the condition. Still, you should be aware of any symptoms that the abscess has returned. The abscess comes back in about 1% to 5% of cases. See your healthcare provider immediately if you notice signs of an abscess.

Is a retropharyngeal abscess life-threatening?

It can be. A retropharyngeal abscess is potentially fatal without treatment. It’s essential to receive treatment as soon as you notice signs of this condition.

Is a retropharyngeal abscess an emergency?

Yes. A retropharyngeal abscess can block your throat to the point that it cuts off your oxygen supply. See your provider well in advance of your condition worsening to this degree.

How do I take care of myself?

Make sure to take all prescribed antibiotics, even if you feel better. Retropharyngeal abscesses can return. Taking all your medicine as directed can reduce the risk that this occurs.

What’s the difference between a retropharyngeal abscess and a peritonsillar abscess?

A retropharyngeal abscess is a collection of pus in the back of your throat. In contrast, a peritonsillar abscess is a collection of pus that forms near your tonsils. Both result from an infection and require similar treatment approaches, including antibiotics and draining the abscess.

A note from Cleveland Clinic

A retropharyngeal abscess is a collection of pus deep in the back of your throat. It isn’t a common infection that you can cure at home. Its potential to block your airway and spread to other organs makes it a medical emergency. Don’t delay seeking care. The sooner you start antibiotics, the greater your chance of getting rid of the abscess and preventing serious complications.