A child presents with 'hot potato voice,' pooling of saliva, stridor, and a bulge in the posterior pharyngeal wall visualised below the level of C2. CT neck shows a retropharyngeal collection. The most feared immediate complication of an untreated retropharyngeal abscess in this child is:

• A Cavernous sinus thrombosis
• B Extension into the parotid space
• C Spontaneous rupture causing aspiration and asphyxia ✓
• D Chronic draining sinus formation

Explanation

The most feared immediate complication of a retropharyngeal abscess is spontaneous rupture with aspiration of pus into the tracheobronchial tree, causing aspiration pneumonia or fatal asphyxia. This is why these abscesses require urgent intravenous antibiotics and surgical drainage (intraoral or external approach). Parapharyngeal spread and mediastinitis (descending necrotising mediastinitis via the danger space) are other serious complications. Securing the airway is the first priority in management.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.