Retropharyngeal abscess in children: clinical presentation, utility of imaging, and current management.
OBJECTIVE
We sought to describe the clinical presentation of patients with retropharyngeal abscess (RPA), utility of imaging studies, and implications on management.


METHODS
A retrospective chart review was performed at a tertiary-care, pediatric hospital with cases identified by a discharge diagnosis of RPA; posttraumatic RPA cases were excluded. Patients without confirmatory radiographic findings, fluoroscopy, or computed tomography (CT) were excluded.


RESULTS
Sixty-four cases involving 64 patients were studied. The median age of the patients was 36 months; 48 (75%) of the 64 patients were younger than 5 years. The most common chief complaints were neck pain (38%), fever (17%), sore throat (17%), neck mass (16%), and respiratory distress or stridor (5%). In 29 children (45%), it was noted that there was limitation of neck extension, in 23 (36.5%) torticollis, and in 8 (12.5%) limitation of neck flexion. The physical examination revealed stridor with wheezing in only 1 patient (1.5%) and wheezing in 1 other (1.5%). Twenty-seven patients (42%) underwent surgery; 37 (58%) were treated with antibiotics only. Performance of a surgical procedure was significantly associated with CT scan findings. Ten (37%) of 27 patients with defined abscess on CT scan were treated with antibiotics alone. There were no treatment failures in either the antibiotic-only group or the antibiotics-plus-surgery group.


CONCLUSIONS
Children with RPA present with limitation of neck movement, especially difficulty extending their neck to look up. They rarely present with respiratory distress or stridor. CT scan is useful to distinguish patients with RPA from those with retropharyngeal cellulitis. Most patients with retropharyngeal cellulitis and some with RPA can be treated successfully without surgery.
Craig
Frances W
FW
Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico, USA.
Schunk
Jeff E
JE
D000293:Adolescent; D002481:Cellulitis / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods*; D005334:Fever / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D005471:Fluoroscopy / Q000379:methods; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008499:Medical Records / Q000706:statistics & numerical data; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D010612:Pharyngitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D012127:Respiratory Distress Syndrome, Newborn / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D017703:Retropharyngeal Abscess / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000628:therapy*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods