Retropharyngeal Abscess

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In occurs in 6months to 4 years of age.

Patients present with: fever, drooling, dysphagia, inspiratory stridor and may hold their head in a torticollis-like position.

If the abscess ruptures, it may result in rapid and fatal airway obstruction. Other complications include, aspiration pneumonia, mediastinitis, and erosion into the jugular vein and carotid artery.

DO NOT palpate as may cause the abscess to rupture.

Investigation is by CT neck with contrast. Plain Xray shows widening of the retropharyngeal space.Usually on plain Xray there is an increase in the retropharyngeal space i.e.., so it is 2x the diameter of the vertebral body at C2, or greater than one half the width of C4

Treatment: Antibiotics:

ampicillin/sulbactam and consider cetriaxone.

IV dexamethasone 0.15-0.6mg/kg

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Dr Peter Kas

Emergency Physician, Educator. Key Interests: Resuscitation, Airway, Emergency Cardiology, Clinical Examination. Creator

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