A child presents with neck stiffness, fever, and an inability to extend the neck following a sore throat. CT shows a posterior pharyngeal collection. What is the MOST significant danger of retropharyngeal abscess?

• A Spread to the parapharyngeal space causing internal jugular vein thrombosis
• B Erosion into the carotid artery causing sudden hemorrhage
• C Direct extension into the spinal cord causing myelitis
• D Extension into the 'danger space' (space 4) between alar and prevertebral fascia, spreading to the posterior mediastinum ✓

Explanation

The retropharyngeal space is bounded anteriorly by the buccopharyngeal fascia and posteriorly by the alar layer of the prevertebral fascia. It communicates with the 'danger space' (space 4), which lies between the alar and prevertebral fascia and extends from the skull base to the posterior mediastinum. Infection in this space can rapidly descend to cause descending necrotizing mediastinitis — a life-threatening complication requiring immediate surgical drainage and mediastinal exploration.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.