Medical expert of the article
New publications
Pharyngeal abscess: causes, symptoms, diagnosis, treatment
Last reviewed: 04.07.2025
All iLive content is medically reviewed or fact checked to ensure as much factual accuracy as possible.
We have strict sourcing guidelines and only link to reputable media sites, academic research institutions and, whenever possible, medically peer reviewed studies. Note that the numbers in parentheses ([1], [2], etc.) are clickable links to these studies.
If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please select it and press Ctrl + Enter.
Retropharyngeal abscess (retropharyngeal abscess, retropharyngeal abscess) is a purulent inflammation of the lymph nodes and loose tissue between the fascia of the pharyngeal muscles and the prevertebral fascia.
ICD-10 code
D39.0 Retropharyngeal abscess.
Epidemiology of retropharyngeal abscess
The disease occurs almost exclusively in childhood due to the fact that the lymph nodes and loose tissue in this area are well developed until the age of 4-5 years, and then undergo involutional changes.
In adults, retropharyngeal abscess is extremely rare and is usually secondary in nature; it can be of a congestive nature in tuberculous and syphilitic spondylitis of the upper cervical vertebrae, or in case of trauma.
Pathogenesis of retropharyngeal abscess
In children, a retropharyngeal abscess occurs as a result of the spread of infection to the lymph nodes during acute nasopharyngitis, tonsillitis, acute infectious diseases (measles, diphtheria, scarlet fever); the disease may be associated with trauma to the posterior pharyngeal wall, adenotomy. The cause of infection of the retropharyngeal space may be a purulent process in the auditory tube and tympanic cavity. The deep retropharyngeal lymph nodes are the first barrier and play the role of regional lymph nodes for the posterior parts of the nasal cavity, nasopharynx, auditory tube and middle ear. The infection spreads through venous or lymphatic pathways or by contact.
Metabolic disorders, weakened immunity, and poor nutrition predispose to the disease. Weakened children are more likely to suffer from retropharyngeal abscess. Cracks in the mother's nipple and early forms of mastitis play a certain role in the infection of the retropharyngeal space in infants.
Symptoms of retropharyngeal abscess
The most common course of retropharyngeal abscess is acute, less often - subacute and chronic. The disease is severe, characterized by a significant increase in temperature (up to 38-39 ° C). Symptoms of intoxication, weakness, sweating are expressed. The position of the head is forced, with a tilt to the sore side and back; moderate rigidity of the occipital muscles, hypersaline, painful and limited opening of the mouth are noted.
Symptoms depend on the location of the retropharyngeal abscess: in the upper, middle or lower pharynx. If it is located in the upper part, difficulty with nasal breathing occurs, accompanied by a nasal tone, and in infants - a violation of the act of sucking. If the retropharyngeal abscess is localized in the oral part of the pharynx, swallowing is upset, pharyngeal stridor appears. If the abscess is in the lower part of the pharynx, the entrance to the esophagus and trachea is compressed - difficulty breathing appears, especially pronounced in the horizontal position of the child. Breathing becomes wheezy and resembles the sound of a working saw, sometimes the voice acquires a hoarse tone.
A constant symptom of a retropharyngeal abscess is swelling and soreness of the lymph nodes in the submandibular region and the posterior cervical lymph nodes, which results in a forced position of the head (tilting to the painful side).
Where does it hurt?
Screening
Examination by an otolaryngologist of children with cervical lymphadenitis, difficulty swallowing, breathing, nasal speech, and forced head position.
Diagnosis of retropharyngeal abscess
Pharyngoscopy reveals a hyperemic, round or oval, asymmetrically located protrusion of the mucous membrane of the posterior pharyngeal wall, often fluctuating upon palpation. When a retropharyngeal abscess is located in the upper pharynx, such a protrusion is visible during posterior rhinoscopy, and when localizing the laryngopharynx, during hypopharyngoscopy. In small children, palpation is often the only possible method of examination; in this case, an elastic, mostly fluctuating, swelling, usually located slightly to the side of the midline, is felt under the finger.
Palpation of the protrusion is sharply painful, and in the case of a retropharyngeal abscess of otogenic origin, palpation results in the appearance of pus in the external auditory canal of the corresponding side.
Chronic retropharyngeal abscess is more common in adults with spondylitis of tuberculous or syphilitic etiology, lasts a long time, and the symptoms are not pronounced.
[ 15 ], [ 16 ], [ 17 ], [ 18 ]
Laboratory research
Usually an inflammatory reaction of the blood is detected: leukocytosis up to 10-15x10 9 /l, shift in the leukocyte formula to the left, increase in ESR up to 40-50 mm/h.
In addition, a puncture of the infiltrate is performed, followed by a microbiological examination of the contents, as well as a blood test with the Wasserman reaction.
Instrumental diagnostics
CT scan, X-ray of the pharynx.
When examining the pharynx in a lateral projection, the inflammatory process in the retropharyngeal space is characterized by the expansion of its shadow; a retropharyngeal abscess is revealed as a limited shadow in a certain area.
Differential diagnosis of retropharyngeal abscess
Most often, a retropharyngeal abscess must be differentiated from a peritonsillar abscess due to the displacement of the tonsil and the arch on the affected side. It should be taken into account that with a retropharyngeal abscess, the tonsil and soft palate are not inflamed; in a doubtful case, it is necessary to carefully examine the back wall of the pharynx, as well as the soft palate and arches.
When the abscess is located in the laryngopharynx, its symptoms resemble those of edematous laryngitis, subglottic laryngitis, and the clinical picture of a foreign body in the larynx.
In older children and adults, a retropharyngeal abscess must be differentiated from a "cold" abscess of tuberculous etiology. In tuberculosis, the process is chronic, long-term, accompanied by general tuberculous intoxication, subfebrile temperature, and mild general and local symptoms. In case of a tuberculous abscess, children complain of pain in the suboccipital fossa, which intensifies with head movements, and try to keep their head still. Additional information is provided by radiography of the cervical spine, which can detect damage to the vertebral bodies.
In differential diagnostics of retropharyngeal abscess with neoplasms of the posterior pharyngeal wall and spine, the slow increase of the latter without an increase in temperature is taken into account. A digital examination and puncture biopsy are mandatory.
In some cases, retropharyngeal abscess is differentiated from retropharyngeal lymphadenopathy, vertebral osteomyelitis, and aneurysm of the ascending pharyngeal artery.
[ 19 ], [ 20 ], [ 21 ], [ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ]
Indications for consultation with other specialists
- Phthisiatrician if tuberculosis is suspected.
- Traumatologist with suspected osteomyelitis of the cervical vertebrae.
- Oncologist if there is a suspicion of a malignant neoplasm.
What do need to examine?
How to examine?
Treatment of retropharyngeal abscess
Treatment goals
Relief of inflammation, drainage of purulent lesions.
Indications for hospitalization
Patients with this disease are subject to emergency hospitalization and inpatient treatment in the ENT department.
Non-drug treatment
Older children are prescribed warm rinses with weak disinfectant solutions. Thermal procedures, UHF at the initial stage of the disease or at the stage of the process subsiding.
Drug treatment
Prescribing broad-spectrum antibiotics and antihistamines.
Surgical treatment
Spontaneous opening of a retropharyngeal abscess occurs late and may lead to asphyxia; prolonged narrowing in the pharynx disrupts nutrition and breathing, leading to exhaustion, anemia, and cachexia. It is for these reasons that an abscess is opened as early as possible. To prevent aspiration of pus into the underlying respiratory tract, the abscess is first punctured with a thick needle and the pus is aspirated with a syringe. Opening is performed through the mouth under local anesthesia or general anesthesia. A narrow scalpel is wrapped in cotton wool or adhesive tape, leaving only its end free (0.5-1.0 cm).
It is better to perform the autopsy with the child lying down with the head tilted back. Under visual control, press the tongue with a spatula and make an incision at the site of the largest bulge, but no further than 3-4 mm from the midline. It is advisable to simultaneously aspirate the pus with a suction device during the autopsy. After the incision and suction of the pus, to completely evacuate it from the abscess, the edges of the incision are spread with Hartmann forceps. After the autopsy, continue gargling and antibiotic therapy.
Specific “cold” abscesses are not opened to avoid secondary infection, and against the background of anti-tuberculosis or anti-syphilitic treatment, repeated punctures are performed with suction of pus and subsequent introduction of specific medicinal solutions.
Further management
Increased level of non-specific resistance of the body.
How to prevent retropharyngeal abscess?
Conducting activities in children aimed at increasing the overall resistance of the body.
What is the prognosis for a retropharyngeal abscess?
With timely recognition and surgical treatment of retropharyngeal abscess, the prognosis is usually favorable. Approximate periods of incapacity for work are 7-14 days.