Retropharyngeal Abscess: Symptoms, Causes, Diagnosis and Treatment

Written by Medicover Team and Medically Reviewed by Dr Shashi Kiran Somala , ENT

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1. Causes 2. Find a Doctor 3. Diagnosis 4. Treatment 5. FAQs

A retropharyngeal abscess (RPA) is a collection of pus that develops in the retropharyngeal space, an area behind the pharynx that extends from the base of the skull toward the upper chest. The infection can cause swelling that affects swallowing and, in severe cases, blocks the airway.

Retropharyngeal abscesses can affect both children and adults but are more common in young children. They often develop when an infection spreads from the upper respiratory tract or lymph nodes. Trauma to the throat can also introduce bacteria into the retropharyngeal space.

A retropharyngeal abscess is a medical emergency because the infection can rapidly cause breathing problems or spread to nearby structures. Early diagnosis and prompt treatment are important to prevent life-threatening complications.

What Are the Types of Retropharyngeal Abscess?

Retropharyngeal abscesses can be classified according to how the infection develops and spreads into the retropharyngeal space.

Primary Retropharyngeal Abscess

A primary retropharyngeal abscess develops when an infection directly involves the retropharyngeal lymph nodes or tissues. It is commonly associated with upper respiratory tract infections, particularly in young children.

Secondary Retropharyngeal Abscess

A secondary retropharyngeal abscess occurs when an infection spreads from a nearby area or develops after trauma. Possible sources include dental infections, sinus infections, throat injuries, foreign bodies, or medical procedures involving the mouth and throat.

What Are the Symptoms of Retropharyngeal Abscess?

The symptoms of a retropharyngeal abscess can develop rapidly and vary depending on the size of the abscess and the extent of the infection. Breathing difficulties require immediate medical attention.

Sore Throat: A persistent sore throat that may become increasingly painful.
Fever: A high temperature that may occur with chills and general weakness.
Difficulty Swallowing: Pain or difficulty when swallowing food, liquids, or saliva.
Neck Pain: Pain, stiffness, swelling, or tenderness in the neck.
Voice Changes: The voice may become muffled, hoarse, or unusually weak.
Drooling: Difficulty swallowing saliva may cause excessive drooling, particularly in children.
Stridor: A high-pitched breathing sound caused by narrowing of the airway.
Difficulty Breathing: Severe swelling can obstruct the airway and cause shortness of breath or respiratory distress.

What Causes a Retropharyngeal Abscess?

A retropharyngeal abscess usually develops when bacteria spread into the tissues behind the throat. The infection may begin in the upper respiratory tract, lymph nodes, teeth, or nearby structures.

Bacterial Infections

Common bacteria associated with retropharyngeal abscesses include Streptococcus species, Staphylococcus aureus, and anaerobic bacteria. The infection may involve more than one type of bacterium.

Upper Respiratory Tract Infections

Infections of the throat, nose, or upper airways can spread to the retropharyngeal lymph nodes and lead to abscess formation, particularly in young children.

Trauma to the Throat

Injuries caused by sharp food particles, foreign objects, medical procedures, or other trauma can introduce bacteria into the retropharyngeal space.

Dental and Nearby Infections

Dental infections, sinus infections, and infections in nearby areas of the head and neck may spread into the deeper tissues behind the throat.

Weakened Immune System

People with weakened immune systems may have a greater risk of developing severe infections that can progress to a retropharyngeal abscess.

When to See a Doctor for Retropharyngeal Abscess?

Medical evaluation is important for severe throat pain, neck swelling, swallowing difficulty, or persistent fever. An ENT specialist usually treats a retropharyngeal abscess, with support from emergency physicians, pediatricians, infectious disease specialists, and surgeons when needed.

You should see a doctor if you have:

Persistent fever with worsening sore throat or neck pain
Difficulty swallowing food, liquids, or saliva
Increasing neck swelling, stiffness, or voice changes

Get medical help immediately if:

You have difficulty breathing, noisy breathing, or stridor
You cannot swallow saliva or develop excessive drooling
You develop severe weakness, confusion, or rapidly worsening symptoms

These could be signs of a serious complication like airway obstruction, which needs urgent care.

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How Is a Retropharyngeal Abscess Diagnosed?

Diagnosing a retropharyngeal abscess involves a clinical examination, imaging studies, and laboratory tests. Doctors must also assess the airway because severe swelling can quickly interfere with breathing.

Clinical Examination

A doctor reviews the symptoms and medical history and examines the throat and neck for swelling, tenderness, stiffness, and other signs of infection. Breathing sounds and voice changes may also provide important diagnostic clues.

Lateral Neck X-ray

A lateral neck X-ray may show abnormal swelling of the soft tissues behind the throat and displacement or narrowing of the airway.

Computed Tomography Scan

A contrast-enhanced CT scan can help confirm the presence, size, and location of the abscess and determine whether the infection has spread to nearby tissues.

Magnetic Resonance Imaging

MRI may be used in selected cases to provide detailed images of the soft tissues and assess the extent of the infection.

Laboratory Tests

Blood tests, including a complete blood count and blood cultures, may help identify signs of infection and determine the causative organism. Samples obtained during abscess drainage may also be tested to guide antibiotic treatment.

How Is a Retropharyngeal Abscess Treated?

Treatment for a retropharyngeal abscess usually requires hospital care because the condition can rapidly affect the airway. Treatment depends on the size of the abscess, severity of symptoms, extent of infection, and the patient's overall condition.

Airway Management

Protecting the airway is the first priority when breathing is affected. Patients with severe swelling or respiratory distress may require urgent airway support.

Antibiotics

Intravenous broad-spectrum antibiotics are commonly started to treat the bacterial infection. The antibiotic regimen may be adjusted after blood or abscess culture results identify the specific bacteria.

Supportive Care

Fluids, pain relief, fever management, and close monitoring may be provided while the infection is treated. Patients who cannot swallow safely may require intravenous hydration.

Surgical Drainage

Surgical drainage may be necessary when the abscess is large, symptoms are severe, the airway is threatened, or the infection does not improve with antibiotics.

Intraoral Drainage: The abscess is drained through the mouth when it can be safely reached from inside the throat.
External Drainage: An incision in the neck may be required for large, deep, or difficult-to-reach abscesses.

Post-Treatment Monitoring

After treatment, patients are closely monitored to ensure that breathing remains stable and the infection resolves completely. Follow-up examinations or imaging studies may be needed in selected cases.

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What Are the Complications of a Retropharyngeal Abscess?

Without prompt treatment, a retropharyngeal abscess can cause serious and potentially life-threatening complications.

Airway Obstruction: Swelling can narrow or completely block the airway.
Sepsis: Bacteria can enter the bloodstream and cause a severe body-wide infection.
Mediastinitis: The infection can spread downward into the chest and affect the tissues around the heart and major blood vessels.
Aspiration Pneumonia: Pus from the abscess may enter the lungs and cause infection.
Spread to Nearby Blood Vessels: Infection may affect major blood vessels in the neck and cause serious complications.
Recurrence: The abscess may return if the infection is not completely treated or drained.

How Can a Retropharyngeal Abscess Be Prevented?

Not every retropharyngeal abscess can be prevented, but early treatment of infections and measures that reduce the risk of throat injuries may help.

Treat Infections Promptly: Seek appropriate medical care for persistent throat, respiratory, dental, or sinus infections.
Maintain Good Oral Hygiene: Regular brushing, flossing, and dental care can reduce the risk of infections spreading from the teeth and gums.
Follow Vaccination Recommendations: Recommended vaccinations can help reduce the risk of certain infections.
Avoid Throat Injuries: Keep sharp objects away from children and seek medical care if a foreign object injures the mouth or throat.
Complete Prescribed Treatment: Take antibiotics exactly as prescribed when they are needed for a bacterial infection.

Frequently Asked Questions

1. What are the causes of a retropharyngeal abscess?

Causes include bacterial infections in the throat or upper respiratory tract, often following a sore throat, tonsillitis, or an upper respiratory infection.

2. What are the symptoms of a retropharyngeal abscess?

Symptoms include difficulty swallowing, fever, neck pain, swollen lymph nodes, and a muffled voice, which may indicate a serious infection.

3. How is a retropharyngeal abscess treated?

Treatment involves antibiotics to fight the infection and, in some cases, surgical drainage if the abscess is large or not responsive to medication.

4. How is a retropharyngeal abscess diagnosed?

Diagnosis is made through physical examination, imaging tests like CT scans or X-rays, and sometimes needle aspiration to confirm the presence of pus.