Retropharyngeal Abscess in Adults: Five Case Reports and Review of the Literature

Abstract

Retropharyngeal abscesses are rare in adults. They occur mostly in immunocompromised patients or as a foreign body complication. We report 5 cases of retropharyngeal abscess collected in the ENT Department of CHU Mohammed VI of Marrakech, during a two-year period (December 2008 to December 2009). Local trauma by foreign body ingestion was the aetiology in four patients. The presenting symptoms, for all patients, were fever, odynophagia, torticollis, and trismus, and the clinical examination showed bulging of the posterior wall of the oropharynx. The radiography of cervical spine showed prevertebral thickening in all cases, this thickening was associated with an aspect of vertebral lysis of the fourth cervical vertebra in one case. A CT scan was performed in all our cases and showed features of retropharyngeal abscess which was associated, in one case, with spondylodiscitis. The biological assessment found one case of diabetes. The intradermal reaction to the tuberculin was clearly positive in one case. Endobuccal abscess puncture was practiced in 4 cases; only one organism was identified by culture: Staphylococcus aureus treatment was based on triple intravenous antibiotics and anti-Koch's therapy (in one case), and the surgical drainage under general anesthesia was also performed in the case of the diabetes patient which required also the correction of hyperglycemia in intensive care unit. The outcome was good in all our patients. The diagnosis of retropharyngeal abscess can be difficult and one must seek a comorbidity; a tuberculosis aetiology must be considered in countries with a high prevalence. The management of these cases is based on antibiotics and surgical drainage.

Giant retropharyngeal abscess in pediatric patient: case report

“…[1,2] Nadir görülen bir durum olmasına rağmen, havayolu obstrüksiyonu, servikal nekrotizan fasiit, mediastinit, juguler ven trombozu, karotis arter anevrizması gibi ölüm-cül komplikasyonlara yol açabilmesi açısından önemlidir. [3][4][5][6] Çoğunlukla üst solunum yolu enfeksiyonuna ikincil gelişen lenf nodlarının süpürasyonuna bağlı olarak oluşur. [7] Sıklıkla çocukluk çağında görülür ve ortalama görülme yaşı 3 ay-3 yaş olarak değişmektedir.…”

“…[5] Çocukluk çağında yetişkinlere oranla daha sık görülmesi-nin en önemli nedeni retrofarengeal lenf nodlarının beş yaşından sonra atrofiye uğramasıdır. [6] Erişkin yaşta retrofarengeal apse ile karşılaşıl-dığında travma ya da geçirilmiş cerrahi öyküsü sorgulanmalıdır. [6] Retrofarengeal apselerde klinik spesifik olmamakla birlikte sıklıkla ateş ve irritabilite gibi semptomlarla karşımıza çıkar.…”

“…[6] Erişkin yaşta retrofarengeal apse ile karşılaşıl-dığında travma ya da geçirilmiş cerrahi öyküsü sorgulanmalıdır. [6] Retrofarengeal apselerde klinik spesifik olmamakla birlikte sıklıkla ateş ve irritabilite gibi semptomlarla karşımıza çıkar. [2,3] Craig ve Schunk [8] retrofarengeal apseli hastaların başını hiperekstansiyona getirememesini "Bolte işare-ti" olarak tanımlamış ve özellikle ayırıcı tanıda yardımcı olduğunu vurgulamışlardır.…”

Giant Retropharyngeal Abscess in a Nigerian Adult Following Fish Bone Throat Injury

“…RPA may present with life threatening upper airway obstruction, as it was in our index patient [1][2][3][4][5]9]. Delay in the diagnosis of RPA is often associated with other serious morbidities such as aspiration pneumonia, sepsis, mediastinitis, empyema and erosion of carotid artery [4,6,11]. The diagnosis is usually made based on clinical symptoms, signs as well as radiological features.…”

“…These lymph nodes are not usually present in adults because they atrophy while the child grows; hence retropharyngeal abscess is not a common disorder among adults. Upper respiratory tract infection is the most common predisposing factor to RPA in children [3][4][5][6] while cervical spine tuberculosis and trauma are the major aetiological factors in adults [3][4][5]7]. Other factors reported among adults include diabetes mellitus [4] and human immunodeficiency virus (HIV) infection [7,8].…”