Retropharyngeal abscesses in children: a 10-year review

Retropharyngeal abscess is a rather rare, deep-neck infection of children and may seriously compromise the airway and mimic other diseases. A retrospective review of 17 cases of retropharyngeal abscess presenting to The Children's Hospital, Denver, from 1976 to 1986 was performed. Nine children (56%) had stridor or airway obstruction. Seven patients (41%) had perforations of their hypopharynx or esophagus, including two neonates (most likely associated with intubation attempts). Two patients presented in the emergency department with a tentative diagnosis of "epiglottitis," while another referred to as having "persistent fever" was found to have a needle embedded in the hypopharynx. Fourteen children (81%) were brought to the operating room for examination and/or drainage of the abscess under general anesthesia. One child received an elective tracheotomy, and two others remained intubated postoperatively, pending resolution of their airway compromise. X-rays of the lateral neck were confirmatory in all these cases, with an unusually high incidence of "air/fluid levels," probably reflecting the corresponding large number of perforations of the hypopharynx or esophagus with subsequent communication into the retropharyngeal space.