Retropharyngeal abscess: a case report

Key words: Retropharyngeal abscess, Infant, Jugular vein thrombosis, Case report

Retropharyngeal abscess is a suppurative infection of deep neck spaces that rarely complicates upper respiratory infections. It most commonly occurs in children under five years of age. The clinical picture can be aspecific, especially in infants, resembling that of pharyngitis, with irritability, refuse of feeding and fever. Limited neck mobility, specifically pain with neck extension, should be the clinical clue to diagnosis, while respiratory findings (airway obstruction or stridor) are rare. Computed tomography of the neck with intravenous contrast is the gold standard for diagnosis. Initial therapy depends upon the severity of respiratory distress and the likelihood of drainable fluid on the basis of imaging. Empiric antibiotic therapy should provide coverage for group B streptococcus, Staphylococcus aureus and respiratory anaerobes. Sometimes surgical management is required. Internal jugular vein thrombosis represents a possible complication with potential of spreading to adjacent structures and to the bloodstream. This paper reports the case of a four-month-old infant with retropharyngeal abscess complicated by jugular vein thrombosis, successfully treated with surgery, antibiotic and anticoagulant therapy.