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Retropharyngeal Abscess

Reviewed by: Mary L. Gavin, MD
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What Is a Retropharyngeal Abscess?

A retropharyngeal (reh-tro-fah-RIN-jee-ul) abscess is an infection that forms behind the back wall of the throat. Retropharyngeal abscesses are uncommon in children.

What Causes a Retropharyngeal Abscess?

A retropharyngeal abscess happens when bacteria grow in the lymph nodes behind the throat. Lymph nodes help fight infections by removing germs, but sometimes they can’t keep up.

When they happen in kids, retropharyngeal abscesses are most common in those under 5 years old. But kids of all ages can get one. An abscess can form after a child has an ear infection, throat infection, or sinus infection. It also can happen after an injury to the neck or throat.

What Are the Signs & Symptoms of a Retropharyngeal Abscess?

At first, a retropharyngeal abscess may cause symptoms of a sore throat, such as a fever, pain with swallowing, and tender lymph nodes in the neck.

Without treatment, symptoms can get worse. A child might:

  • drool
  • refuse to eat or drink
  • have a stiff neck and not want to move it because of pain
  • have a swollen neck or glands
  • keep their mouth closed tight
  • speak in a hoarse or muffled voice
  • have trouble breathing or noisy breathing
  • have chest pain

How Is a Retropharyngeal Abscess Diagnosed?

A doctor usually can diagnose a retropharyngeal abscess based on symptoms and by examining a child’s mouth, throat, and neck.

If a retropharyngeal abscess seems likely, the child should see an ear, nose, and throat (ENT) specialist. Blood tests, X-rays, or a CT scan can help doctors make the diagnosis.

How Is a Retropharyngeal Abscess Treated?

A child with a retropharyngeal abscess needs treatment in a hospital. Doctors will give IV (into a vein) antibiotics and might need to do surgery to drain the abscess. This is recommended if:

  • The child has breathing problems.
  • The abscess is very large.
  • Symptoms don’t improve after 1 or 2 days on antibiotics.

If a child has breathing problems, doctors will use a breathing tube to keep the airway open before the child has surgery.

Most children can switch to oral antibiotics if their symptoms improve after several days of IV antibiotics.

When Should I Call the Doctor?

Call your doctor if you child has a sore throat and fever. Get medical care right away if your child:

  • has a high fever
  • is drooling and can’t swallow 
  • has a stiff neck
  • has trouble breathing
Reviewed by: Mary L. Gavin, MD
Date reviewed: January 2021