A 2 yo female presents to the ED with fever and difficulty swallowing. Mom reports she has been fussy with intermittent fever and rhinorrhea for 4 days but today did not want to eat or drink much, talking in a whisper and c/o pain when eating.  On exam, the patient is febrile, drooling, and has a swollen posterior orpharynx.  A soft tissue neck x-ray is shown.  What's the diagnosis?  Scroll down for answer.

Answer:  Retropharyngeal abscess

• Most common in children under 5 years
• May be preceeded by URI symptoms or trauma to posterior pharynx
• xray finding = widened prevertebral space
• In children, consider abscess when the prevertebral space is >6mm at C2 or >22mm at C6
• accurate assessment requires neck extension during x-ray
• Common organsims involved - often polymicrobial, Staph aureus, Strep pyrogens, Strep viridans, Fusobacterium, Haemophilus specieas or other respiratory anaerobes
• Management 
• Admission 
• IV antibiotics
• Consult ENT for possible I&D
• Definitive airway if any respiratory compromise

• Complications include airway obstruction and mediastinitis

References

Jain H, Knorr TL, Sinha V. Retropharyngeal Abscess. [Updated 2019 Oct 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:https://www.ncbi.nlm.nih.gov/books/NBK441873/

Mapelli E, Sabhaney V. Stridor and Drooling in Infants and Children. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM. eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8eNew York, NY: McGraw-Hill; 2016.