Retropharyngeal abscess

Retropharyngeal abscess most often affects children under age 5, but it can occur at any age.

Infected material (pus) builds up in the space around the tissues at the back of the throat. This can occur during or very soon after a throat infection.

Symptoms include:

• Breathing difficulty
• Difficulty swallowing
• Drooling
• High fever
• High-pitched sound when inhaling (stridor)
• Muscles between the ribs pull in when breathing (intercostal retractions)
• Severe throat pain
• Difficulty turning the head

The health care provider will perform a physical exam and look inside the throat. The provider may gently rub the back of the throat with a cotton swab. This is to take a sample of tissue to check it more closely. It is called a throat culture.

Other tests may include:

• Complete blood count (CBC)
• CT scan of the neck
• X-ray of the neck
• Fiber optic endoscopy

Surgery is needed to drain the infected area. Corticosteroids are sometimes given to reduce airway swelling. High-dose antibiotics are given through a vein (intravenous) to treat the infection.

The airway will be protected so that it does not become completely blocked by the swelling.

It is important to get medical help right away. This condition can lead to blockage of the airway. This is a life-threatening medical emergency. With prompt treatment, a full recovery is expected.

Complications may include:

• Airway obstruction
• Aspiration
• Mediastinitis
• Osteomyelitis

Contact your provider if you or your child develops a high fever with severe throat pain.

Get medical help right away if you have:

• Breathing trouble
• High-pitched breathing sounds (stridor)
• Retraction of the muscles between the ribs when breathing
• Difficulty turning the head
• Difficulty swallowing

Prompt diagnosis and treatment of a sore throat or upper respiratory infection can prevent this problem.

James P, Hanna S. Upper airway obstruction in children. In: Bersten AD, Handy JM, eds. Oh's Intensive Care Manual. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 106.

Pappas DE, Hendley JO. Retropharyngeal abscess, lateral pharyngeal (parapharyngeal) abscess, and peritonsillar cellulitis/abscess. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 410.

Roginski MA, Atchinson PR. Upper respiratory tract infections. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 61.

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.