What to Know About a Retropharyngeal (Lymph Node) Abscess

A retropharyngeal abscess is a swelling in the neck caused by an infection. It is most often caused by bacteria that can multiply and create a pocket of infection in the interior lymph nodes of the neck.

The development of a retropharyngeal abscess is a medical emergency that can be life-threatening. Urgent treatment is necessary because this abscess can impact your ability to swallow and breathe. In this article, learn about the common causes that lead to a retropharyngeal abscess and how it is treated. 

Retropharyngeal Abscess in Children

Children younger than age 5 are at the highest risk for developing a retropharyngeal abscess. However, anyone can develop one.

The most common cause of a retropharyngeal abscess in young children is a prior infection, like an ear infection, sinus infection, or throat infection. An injury (such as swallowing an object) or trauma to the neck or throat can also result in an abscess.

The abscess can develop because lymph nodes in the neck become swollen during an infection. The swollen lymph nodes carry a risk of becoming infected by bacteria and developing into a full abscess, which requires medical treatment.

An abscess is a walled-off cavity filled with pus—a collection of bacteria, debris, and white blood cells. It can be difficult for the immune system to destroy bacteria inside an abscess.

Risk in Adults

A retropharyngeal abscess is less common in adults compared to children. The reasoning behind this lies in how the body develops and changes as a person grows older.

With age, the lymph nodes behind the throat that are most often infected regress and disappear. Usually, this process starts around the age of 5. As a result, older children and adults are far less likely to develop a retropharyngeal abscess compared to young children.

However, there is always still a possibility that a retropharyngeal abscess can develop in an adult. For instance, it has been seen as a rare complication of COVID-19.

Bacteria and Lymph Nodes

Lymph nodes are located throughout the body and play an important role in preventing and responding to infections. The lymph nodes are a source of white blood cells, which help respond to infectious organisms, such as bacteria and viruses.

When an infection occurs, the lymph nodes often swell as the immune system ramps up a defensive response. While lymph node swelling is a positive action the body takes in response to an infection, it can sometimes cause additional problems.

One issue occurs when bacteria native to the body enter the swollen tissues and cause an additional infection. These bacteria natively live in the mouth or on the skin without causing any trouble. However, if the bacteria move into a lymph node, there is a small possibility they can multiply and cause an abscess.

Symptoms

Symptoms of a retropharyngeal abscess include:

• Neck pain and/or stiffness
• Fever
• Sore throat
• Swelling in the throat
• Redness in the back of the throat
• A bulge in the back of the throat
• Difficulty swallowing
• Difficulty talking or changing voice
• Difficulty breathing 
• Ear pain

These symptoms are nonspecific, meaning they also can occur with other conditions. However, if you or your child experiences these symptoms, get prompt medical attention. A retropharyngeal abscess is serious.

Diagnostic Tests

The diagnostic tests for the evaluation of a retropharyngeal abscess are a combination of laboratory and imaging tests. The combination of tests can determine if there is an infection, and imaging can detect the location of the abscess. Commonly used laboratory  tests include:

• Complete blood count (CBC): A blood test that can indicate an infection
• Erythrocyte sedimentation rate: A blood test that can indicate inflammation
• Blood cultures: A blood test that can identify bacteria and other germs in the bloodstream
• Respiratory swabs: Can identify bacterial or viral infections

Commonly used imaging tests may include:

• Computed tomography (CT) scan: A CT of the neck is considered the definitive study for diagnosis.
• X-ray 
• Ultrasound 
• Magnetic resonance imaging (MRI) 

Treatment

Once an abscess develops, it can be difficult for the body’s immune system to clear out the infection. The treatment for a retropharyngeal abscess often requires intravenous (IV) antibiotics to treat the bacterial infection, as well as a needle aspiration or surgical drainage of the abscess.

Smaller abscesses may only need antibiotics, but often these are given intravenously (within a vein) in a hospital setting.

Antibiotic Resistance

Antibiotic resistance—when germs develop the ability to not respond to drugs made to kill them—is a growing issue in the treatment of infections. Since several types of bacteria can often be involved in a retropharyngeal abscess, a broad-spectrum antibiotic that can kill multiple types of bacteria is often required.

Broad-spectrum antibiotics are extremely useful for the treatment of infections. However, they can carry a risk of bacteria developing antibiotic resistance. Your healthcare team may start with a broad-spectrum antibiotic and then choose one that matches the resistance pattern of the bacteria identified in the abscess.

Life-Threatening Complications

The airway (trachea) can become blocked by a retropharyngeal abscess. Blocking the airway can disrupt the ability to breathe normally, which is a medical emergency.

Maintaining a clear airway is critical in the treatment of a retropharyngeal abscess. In some cases, emergency intubation is required, and a tube is placed into the airway to support breathing. Intubation is necessary until the abscess can be appropriately treated and the airway is not blocked.

Summary

A retropharyngeal abscess is a medical emergency that often requires urgent medical treatment. In some cases, the airway can become impacted by an abscess, requiring advanced treatment and intubation. Fortunately, there are treatment options, such as antibiotics and drainage, that have good success in treating a retropharyngeal abscess.