IS Case 551: Retropharyngeal abscess

Stephanie Soehnlein, MD

University of Rochester

Imaging Sciences URMC 2010
Publication Date: 2010-09-18


A previously healthy 19-month-old female presented with fever for 4 days with poor food intake, increased drooling, and increased work of breathing and intermittent grunting. Patient was previously thought to have hand, food, and mouth disease secondary to oropharynx and hand lesions.


Plain film findings demonstrated prevertebral soft tissue swelling and possible right paramediastinal adenopathy. CT findings demonstrated a large retropharyngeal abscess with extension into the right pleural space and mediastinum.


Retropharyngeal abscess


The retropharyngeal space is defined by fascial and soft tissue planes. Infections in this region can be caused by tonsillitis, pharyngitis, otitis, and oral cavity infections. It is most common in the pediatric population below the age of 6. A retropharyngeal abscess can remain clinically occult in the young pediatric population, as signs and symptoms can mimic other processes. Associated empyema is an uncommon complication of retropharyngeal abscess. The presence of widened mediastinum and increased paratracheal opacity on plain radiographs increases the suspicion of this complication. Prevertebral soft tissue swelling in the pediatric population should raise clinical suspicions for retropharyngeal abscess as the contents of the retropharyngeal space are limited.


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