These patients prefer to lie flat vs. epiglottitis patients prefer to sit up/tripoding - Brit Long & Michael Gottlieb
image by: Lacy Fallis
Retropharyngeal abscesses typically occur in children <5 yrs of age (as the retropharyngeal lymph tissue atrophy after this time). They can also occur after direct trauma (from a popsicle stick or other foreign objects impaling the adjacent structures) in older kids and “big babies” (AKA adults).
As often occurs, the classic teaching is not the common finding. You may have been taught that retropharyngeal abscesses present with signs of respiratory distress (stridor, tachypnea, drooling)… and this can occur; however, if you wait for the purulent puss pocket to cause such symptoms it has grown large enough to encroach upon the airway. It would be beneficial for all…
Look for neck stiffness or limited range of motion of the neck. Limited ROM of the neck may present as dramatically as torticollis or more subtly as the patient refusing to look in a direction.
The peak incidence occurs in 3- to 5-year-olds. It is rare beyond 6 years of age as the retropharyngeal lymph nodes involute.
Lateral neck soft tissue XRAY: Evaluation of prevertebral soft tissue. Should be obtained in extension on inspiration: Flexion of the neck, expiration and crying may result in pseudo-enlargement.
How do you diagnose retropharyngeal abscess? Lateral neck X-ray or CT scan.Anteroposterior (AP) diameter of soft tissues along anterior bodies of C1- 4 should be less than 40% of the AP diameter of the vertebral body behind it.
Ted Brenkert sticks his neck out to educate you on retropharyngeal abscesses. RPAs can be an especially worrisome diagnosis in young children who will present with fever, sore throat and limitation of neck movement.
Pearl: these patients prefer to lie flat (vs. epiglottitis patients prefer to sit up/tripoding)
Retropharyngeal abscesses are uncommon but potentially life-threatening diagnosis. They can occur at any age, although are most commonly found in children under the age of five.
Patients may prefer to lay supine to prevent abscess and edematous posterior wall to collapse into airway, so patients should not be forced to sit up
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