What is the pathophysiology of a retropharyngeal abscess (RPA)?

Updated: Jan 08, 2021
  • Author: Joseph H Kahn, MD; Chief Editor: Gil Z Shlamovitz, MD, FACEP  more...
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The retropharyngeal space is posterior to the pharynx, bound by the buccopharyngeal fascia anteriorly, the prevertebral fascia posteriorly, and the carotid sheaths laterally. It extends superiorly to the base of the skull and inferiorly to the mediastinum.

Abscesses in this space are often polymicrobial; they can be caused by the following organisms:

  • Aerobic organisms, such as group A streptococci and Staphylococcus aureus, including methicillin-resistant S aureus (MRSA) [10]

  • Anaerobic organisms, such as species of BacteroidesVeillonella, Prevotella, Peptostreptococcus, Fusobacterium, and Porphyromonas [10]

  • Gram-negative organisms, such as Pseudomonas (in high-risk groups), Haemophilus influenzae, H parainfluenzae, and others [11, 12]

The high mortality rate of retropharyngeal abscess is owing to its association with airway obstruction, mediastinitis, aspiration pneumonia, epidural abscess, jugular venous thrombosis, necrotizing fasciitis, sepsis, and erosion into the carotid artery.

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