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Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management

Frances W Craig1, Jeff E Schunk

  • 1Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA.

Pediatrics
|June 5, 2003
PubMed

Insights

Retropharyngeal abscess (RPA) in children often presents with neck pain and limited neck movement, rarely with stridor. Imaging like CT scans helps differentiate abscess from cellulitis, guiding treatment decisions. Many patients can be successfully treated without surgery.

Area of Science:

  • Pediatric Otolaryngology
  • Pediatric Infectious Diseases
  • Pediatric Emergency Medicine

Background:

  • Retropharyngeal abscess (RPA) is a serious infection in children, potentially leading to airway compromise.
  • Understanding the typical clinical presentation and diagnostic utility of imaging is crucial for timely management.
  • Previous studies have varied in their focus on clinical signs, imaging, and treatment outcomes.

Purpose of the Study:

  • To describe the clinical presentation of pediatric retropharyngeal abscess (RPA).
  • To evaluate the utility of imaging studies in diagnosing RPA.
  • To analyze the implications of diagnostic findings on patient management and treatment outcomes.

Main Methods:

  • Retrospective chart review at a tertiary-care pediatric hospital.
  • Inclusion criteria: discharge diagnosis of RPA; exclusion: post-traumatic cases and those lacking confirmatory imaging (radiography, fluoroscopy, CT).
  • Data collected on patient demographics, chief complaints, physical examination findings, imaging results, and treatment modalities.

Main Results:

  • 64 pediatric cases of RPA were analyzed; median age 36 months, 75% younger than 5 years.
  • Common symptoms included neck pain (38%), fever (17%), sore throat (17%), and neck mass (16%). Limitation of neck extension was observed in 45% of patients.
  • Surgery was performed in 42% of cases; 58% were treated with antibiotics alone. CT scan findings significantly influenced surgical decisions. No treatment failures were reported in either treatment group.

Conclusions:

  • Pediatric RPA commonly presents with neck movement limitations, particularly difficulty with neck extension, and rarely with respiratory distress or stridor.
  • Computed tomography (CT) scans are valuable in differentiating RPA from retropharyngeal cellulitis.
  • A significant proportion of patients, including some with RPA and most with retropharyngeal cellulitis, can be managed successfully with antibiotics alone, avoiding surgery.
Abstract

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