Retropharyngeal abscess

Case contributed by Derek Smith


One week sore throat, now presenting with difficulty swallowing. Marked inflammatory response (WCC >30, CRP >500).

Patient Data

Age: 45 years
Gender: Female

Edema of the oropharyngeal airway.

Enhancing collection in the right posterior pharyngeal wall in communication with a large retropharyngeal abscess. This retropharyngeal collection extends up to the C2 level and inferiorly involves the visceral space with abscess surrounding the left thyroid lobe and the plane between the right thyroid and trachea.

Laterally, abscess extends into the right parapharyngeal space and along the deep margin of the medial pterygoid muscle. Stranding but no collection in the right submandibular space. No floor of mouth extension.

Reactive bilateral nodal enlargement. Normal opacification of major vessels.

Some devitalised teeth with periapical lucencies, but no odontogenic abscess or communication with the neck collection.

Normal cervical spine; no CT evidence of spondylodiscitis.

Case Discussion

An extensive deep neck space infection. A primary airway infection was favored given the right posterior pharyngeal / peritonsillar collection.

A CT chest was performed (which did not demonstrate any mediastinal extension) prior to emergency theater for drainage.

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