Abscess, Retropharyngeal:
Clinical:
A retropharyngeal abscess usually occurs secondary to a nasopharyngeal
infection and is most common in infancy (3-4y). Patients present with fever,
stiff neck, cervical adenopathy, and dysphagia. The infection is usually
polymicrobial (Staph, Strep). Potential complications include: rupture
with aspiration, compromised airway, mediastinitis, C-spine osteomyelitis,
vascular erosion, or septic venous thrombosis.
X-ray:
On airway films there is widening of the retropharyngeal/prevertebral soft
tissues and smooth anterior deviation of the airway (if deviation is "L"
shaped it may be due to swallowing). Soft tissue air or a foreign body
can be seen. Fluoro may be useful if the child is very irritable. Differential
considerations for a mass in this location include: Cystic hygroma, hemangioma,
foreign body, hematoma (trauma/C-spine injury), adenopathy, lymphoma, Histiocytosis
X, neurofibroma, or rhabdomyosarcoma.
