Retropharyngeal Abscess

Etiology Polymicrobial
S. pyogenes 
S. aureus 
Gram-negative rods
Oral anaerobes
Age 6 mo–4 y old
Rare >4 years 
Onset Insidious over 2–3 d after an upper respiratory infection or local trauma
Effect of positioning on symptoms Neck stiffness and hyperextension
Stridor Inspiratory when severe
Cough No
Voice Often muffled
"Hot potato"
Drooling Yes
Dysphagia Yes
Radiologic appearance CT neck W/ IV Contrast
Thickened bulging retropharyngeal soft tissue 
Management 1. Immediate airway stabilization is the first priority. Intubate unstable pt before CT.
2. ABx:
 - Unasyn 50 mg/kg/dose IV
 - Clindamycin 10 10 mg/kg IV
 - PNC Allergy: Rocephin 50 mg/kg/dose
3. Steroids:
 - Dexamethasone
0.15 to 0.6 mg/kg IV
 - Max: 10 mg
 - Solu-Medrol 125mg IV/IM
4. Consult otolaryngology for operative I&D as indicated. Although cellulitis & some very small abscess may do well with ABx alone, most require surgery.

Source: Tintinalli 7th ed