Retropharyngeal abscess (RPA) usually presents with fever, difficulty in swallowing, excessive drooling, sore throat, changes in voice, or neck stiffness. Limitation in neck movement on examination, especially with hyperextension, or torticollis may be an important finding. The resultant edema represents cellulitis and suppurative adenitis of the lymph nodes located in the prevertebral fascia and is seen on a soft tissue lateral x-ray of the neck as prevertebral soft tissue thickening. The RPA may be preceded by an upper respiratory infection, pharyngitis, otitis media, or a wound infection following a penetrating injury into the posterior pharynx. It is helpful for the examiner to be familiar with the normal laryngeal structures. The differential diagnosis includes pharyngitis, acute laryngotracheobronchitis, epiglottitis, membranous (bacterial) tracheitis, cervical adenitis, infectious mononucleosis, peritonsillar abscess, foreign body aspiration, and diphtheria. These patients may present with stiff neck mimicking meningitis.
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