Retropharyngeal abscess

Key words: Retropharyngeal abscess, Fever, Neck stiffness

The retropharyngeal abscess is a rare pathology nonetheless it has always to be considered in presence of fever (hyperpyrexia) and neck stiffness. In fact, it can be burdened by an important morbidity and mortality, however the advent of antibiotics and CT has reduced its complications. The clinical picture is varied and not specific, sharing signs and symptoms with the oropharyngeal infections. The bulging of the posterior pharyngeal wall is pathognomonic, but it is present in less than half of the cases. Particular attention must be paid to children under one year of age that are more susceptible to complications, because of the immaturity of the immune system and a more not specific clinic, with a consequent late diagnosis. The most frequently involved pathogens are group A beta-haemolytic Streptococcus, Staphylococcus aureus (including methicillin-resistant Staphylococcus aureus) and oropharyngeal anaerobes. The gold standard for diagnosis is contrast CT. The therapeutic approach depends on the clinic. Medical therapy can be attempted in case of clinical stability and small size, setting intravenous antibiotic therapy with a third-generation cephalosporin associated with ampicillin-sulbactam or clindamycin. If there is no clinical improvement within 24-48 hours - or in the first instance in case of respiratory distress or abscess greater than or equal to 2.5 cm2 in two-dimensional projection - the surgical approach should be considered.