Retropharyngeal Abscess (RPA) is a serious medical condition that occurs in the potential space between the prevertebral fascia posteriorly, the posterior pharyngeal wall anteriorly, the carotid sheaths anteriorly, the base of the skull superiorly and the mediastinum inferiorly. RPA is most commonly seen in children between the ages of two and six years old.

The cause of RPA is typically the spread of infection from the teeth, middle ear, tonsils or the sinuses. The most common bacteria associated with RPA are streptococcus pyogenes, staphylococcus aureus and Haemophilus influenzae.

Classic symptoms of RPA include fever, sore throat, restricted neck movements, odynophagia (painful swallowing), cervical lymphadenopathy and occasionally an altered voice. The examination may reveal a neck mass, fever, cervical adenopathy, neck stiffness or torticollis, agitation, lethargy, drooling, trismus (limited opening of the jaw) and stridor (noisy breathing).

Radiological imaging is essential for the diagnosis of RPA. A lateral soft tissue neck x-ray can show an enlarged prevertebral soft tissue shadowing greater than 7 mm at the level of C2 and greater than 14 mm at C6. A CT neck scan can show a ring-enhancing lesion in the retropharyngeal space.

The management of RPA typically involves IV antibiotics with or without surgical drainage. The involvement of an ENT surgeon is crucial, as any signs of airway compromise should prompt an urgent review by a paediatric anaesthetist.