Retropharyngeal abscess
A retropharyngeal abscess (RPA) is a deep‑neck space infection with a purulent collection in the retropharyngeal space (between the posterior pharyngeal constrictor muscles and the prevertebral fascia).
It most commonly affects young children (especially under 5 years) and is a potentially life‑threatening cause of airway compromise and systemic sepsis. Rapid recognition, airway‑focused resuscitation and urgent specialist (ENT/paediatric surgery/anaesthetics) involvement determine outcome.
Anatomy and pathogenesis
The retropharyngeal space extends from the skull base inferiorly into the superior mediastinum and is bounded anteriorly by the pharynx and posteriorly by the prevertebral fascia.
In young children it contains lymph nodes (nodes of Rouvière) that drain the nasopharynx, middle ear and posterior pharynx; these nodes involute with age and explain the paediatric predominance.
Infection of these nodes or direct spread from adjacent structures (tonsils, sinuses, dental infections, penetrating trauma) can progress from cellulitis to a loculated abscess. Inferior extension risks mediastinitis and lateral spread can involve the parapharyngeal space.
Epidemiology and common organisms
RPA is most frequently seen in children under 5 years but occurs in older children and adults. Microbiology is typically polymicrobial and commonly includes aerobic streptococci, Staphylococcus aureus (including MRSA/PVL strains where prevalent) and anaerobic oral flora. Local microbiology patterns should guide therapy.
Clinical features and red flags
Presentation may be subacute (24-72 hours) or more rapid, and children...