Retropharyngeal Fluid Collection Emergencies
Summarized by: Akshay Wadera, M.D.
Original publication details
Authors: Hayato Tomitaa, Tsuneo Yamashiroa, Hirotaka Ikedaa, Atsuko Fujikawaa,
DOI: https://doi.org/10.1016/j.ejrad.2016.04.001
Reference: Tomita, H., Yamashiro, T., Ikeda, H., Fujikawa, A., Kurihara, Y., & Nakajima, Y. (2016). Fluid collection in the retropharyngeal space: A wide spectrum of various emergency diseases. European Journal of Radiology, 85(7), 1247–1256.
Retropharyngeal Abscess
Clinical
Infection
Imaging
RPS fluid collection with rim enhancement
Complications
Mediastinitis
Airway obstruction
Vascular complications (internal jugular vein thrombosis/septic thrombophlebitis, internal carotid artery stenosis/pseudoaneurysm)
Osteomyelitis
Clinical
Infection
Imaging
RPS fluid collection with rim enhancement
Bony destructive changes
Paraspinal soft tissue swelling
Complications
Airway obstruction
Retrophayngeal Abscess
Esophgeal perforation**
Mediastinitis**
Trachoesophageal fistula**
**Important to evaluate in the setting of suspected battery ingestion
Foreign Body Ingestion
Clinical
Foreign body trigger
Imaging
RPS fluid collection (abscess, hematoma) associated with a foreign body/trigger
Complications
Epidural abscess
Spinal cord compression
Calcific Tendinitis of the Longus Collii Muscle
Clinical
Sudden onset, can present similarly to abscess (fever, sore throat, dysphagia)
Imaging
RPS fluid collection without rim enhancement
Amorphous calcifications of longus collii muscle (most often at C1-C2 levels)
Kawasaki Disease
Clinical
Fever lasting 5 days + specific criteria
Imaging
RPS fluid collection without rim enhancement
Cervical lymphadenopathy (+/- necrosis)
Complications
Coronary artery aneurysm
Pyiform Sinus Cyst/Fistula
Clinical
+/- Thyroiditis symptoms
Imaging
Fistula tract
Suppurative thyroiditis
RPS fluid collection
Complications
Suppurative thyroiditis
Airway obstruction
Retropharyngeal abscess
Lymphatic Malformation
Clinical
Neck mass
Imaging
Well-defined smooth or lobular non-enhancing cystic mass +/- minimally-enhancing septa
Complications
Airway obstruction
Active bleeding
Cosmetic
Malignant Lymphoma
Clinical
Neck mass
Imaging
RPS fluid collection without rim enhancement
Large lymphadenopathy (can be necrotic)
Angioedema
Clinical
Subcutaneous soft tissue/mucosal swelling with a trigger***
Imaging
Fluid collection without rim enhancement in RPS with a trigger
Complications
Airway obstruction
***Triggers include medications, food, physical stimuli (i.e. pressure)
Retropharyngeal Hematoma
Clinical
Trauma
Carotid artery rupture
Foreign body ingestion
Anticoagulation complication
Iatrogenic from cerebral angiography
Imaging
Fluid/blood collection in RPS + compatible history(i.e. cervical spine fracture)
Complications
Airway obstruction
Citation
Tomita, H., Yamashiro, T., Ikeda, H., Fujikawa, A., Kurihara, Y., & Nakajima, Y. (2016). Fluid collection in the retropharyngeal space: A wide spectrum of various emergency diseases. European Journal of Radiology, 85(7), 1247–1256. https://doi.org/10.1016/j.ejrad.2016.04.001