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PEDIATRICS Vol. 111 No. 6 June 2003, pp. 1394-1398

Retropharyngeal Abscess in Children: Clinical Presentation, Utility of Imaging, and Current Management

Frances W. Craig, MD^* and Jeff E. Schunk, MD

^* Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico
Department of Pediatrics, University of Utah School of Medicine, Primary Children’s Medical Center, Salt Lake City, Utah

Objective. We sought to describe the clinical presentation of patients with retropharyngeal abscess (RPA), utility of imaging studies, and implications on management.

Methods. A retrospective chart review was performed at a tertiary-care, pediatric hospital with cases identified by a discharge diagnosis of RPA; posttraumatic RPA cases were excluded. Patients without confirmatory radiographic findings, fluoroscopy, or computed tomography (CT) were excluded.

Results. Sixty-four cases involving 64 patients were studied. The median age of the patients was 36 months; 48 (75%) of the 64 patients were younger than 5 years. The most common chief complaints were neck pain (38%), fever (17%), sore throat (17%), neck mass (16%), and respiratory distress or stridor (5%). In 29 children (45%), it was noted that there was limitation of neck extension, in 23 (36.5%) torticollis, and in 8 (12.5%) limitation of neck flexion. The physical examination revealed stridor with wheezing in only 1 patient (1.5%) and wheezing in 1 other (1.5%). Twenty-seven patients (42%) underwent surgery; 37 (58%) were treated with antibiotics only. Performance of a surgical procedure was significantly associated with CT scan findings. Ten (37%) of 27 patients with defined abscess on CT scan were treated with antibiotics alone. There were no treatment failures in either the antibiotic-only group or the antibiotics-plus-surgery group.

Conclusions. Children with RPA present with limitation of neck movement, especially difficulty extending their neck to look up. They rarely present with respiratory distress or stridor. CT scan is useful to distinguish patients with RPA from those with retropharyngeal cellulitis. Most patients with retropharyngeal cellulitis and some with RPA can be treated successfully without surgery.

Key Words: retropharyngeal abscess • children • pediatric

Abbreviations: RPA, retropharyngeal abscess • CT, computed tomography • PCMC, Primary Children’s Medical Center • CSF, cerebrospinal fluid • RPC, retropharyngeal cellulitis

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Received for publication Dec 27, 2001; Accepted Dec 20, 2002.

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