Retropharyngeal Infections: Cellulitis, Suppurative Adenitis, Abscess

Epidemiology

Acute pharyngitis is common in childhood and most often affects children < 3 years of age. The most likely causal organism is Haemophilus influenzae. Retropharyngeal cellulitis or abscess in children is usually secondary to acute pharyngitis. In adults, infection is usually due to penetrating injury, and gram-positive cocci are the most common pathogen.

Clinical Findings

Patients often present with fever with the sensation of a lump in the throat. Patients may also complain of a choking feeling and difficulty in swallowing. Inspection of the pharynx will reveal edema and redness.

Pathology

From the pharynx, microorganisms can spread to the retropharyngeal nodes resulting in suppurative adenitis. If treatment is delayed, suppurated lymph nodes may rupture and result in formation of a retropharyngeal abscess.

Treatment

Acute pharyngitis and lymphadenitis can be readily controlled with antibiotics. Retropharyngeal abscess should be surgically managed expediently because rapid enlargement may lead to airway compromise.

Imaging Findings

Plain Films

This demonstrates thickening of the soft tissues in the prevertebral space. This is a nonspecific finding and may be seen in retropharyngeal cellulitis, retropharyngeal suppurative adenitis, and retropharyngeal abscess formation.