Deep Neck Infection: A Case of Retropharyngeal Abscess

The incidence of retropharyngeal abscesses has been decreasing since the introduction of antibiotic therapy, and it is currently a rare diagnosis in adults, although there are some recent cases in the literature. Given its seriousness, if not treated promptly, the infection can progress rapidly and its complications can be fatal, making it a serious health problem. A 79-year-old woman presented at her primary care center with complaints of persistent odynophagia for about two weeks and rapidly progressive dysphagia in five days, initially for solids and later for solids and liquids. On observation, she had difficulty swallowing saliva and presented a painful mass in the bilateral anterior submental and anterior cervical region. Due to the rapid progression of symptoms and the findings of the physical examination, the patient was referred to the emergency department for a suspected abscess or cervical mass. In the emergency department, a cervical CT scan was performed, which revealed a retropharyngeal abscess measuring approximately 7 x 6 x 4 cm, involving the right carotid artery and internal jugular vein, with compression of the internal jugular vein. The patient was admitted to the otorhinolaryngology department, where intravenous antibiotic therapy with third-generation cephalosporin and clindamycin was initiated. She underwent exploration in the operating room to determine the cause of the abscess and transoral drainage of the already spontaneously draining abscess. After completing antibiotic therapy, a follow-up CT scan showed complete resolution of the abscess without suggestive masses of neoplasm or foreign bodies, therefore, the cause of the abscess has not been identified.  The most frequent cause of retropharyngeal abscess in adults is dental septic foci and another commonly described cause is the ingestion of foreign bodies such as fish bones or chicken bones. Early diagnosis of this condition is crucial, as delays in treatment initiation can lead to the progression of infection into the deep cervical spaces, resulting in serious complications such as mediastinitis, pericarditis, jugular vein thrombosis, sepsis, laryngeal edema, conditions with a high degree of morbidity and mortality. Therefore, it is important for any doctor to be aware of warning signs and symptoms in patients who present such symptoms, especially primary care doctors, who are the first gateway to health services and to whom patients often turn first. This case report shows the importance of suspicion and subsequent referral for timely diagnosis and treatment.