Problemi speciali
Gli ascessi retrofaringei
Retropharyngeal abscess
Luca Bernardini1, Laura Serra2, Elisabetta Calamelli2, Paolo Bottau2, Deborah Silvestrini2, Andrea Pession1,3
1Scuola di Specializzazione in Pediatria, Alma Mater Studiorum, Università di Bologna
2UO di Pediatria e Nido, Ospedale Santa Maria della Scaletta, Imola (Bologna)
3UO di Pediatria, Policlinico di Sant’Orsola, Bologna
Marzo 2020 - pagg. 161 -166
Abstract
The retropharyngeal abscess is a rare pathology nonetheless it has always to be considered
in presence of fever (hyperpyrexia) and neck stiffness. In fact, it can be burdened
by an important morbidity and mortality, however the advent of antibiotics and CT has
reduced its complications. The clinical picture is varied and not specific, sharing signs
and symptoms with the oropharyngeal infections. The bulging of the posterior pharyngeal
wall is pathognomonic, but it is present in less than half of the cases. Particular attention
must be paid to children under one year of age that are more susceptible to complications,
because of the immaturity of the immune system and a more not specific clinic,
with a consequent late diagnosis. The most frequently involved pathogens are group
A beta-haemolytic Streptococcus, Staphylococcus aureus (including methicillin-resistant
Staphylococcus aureus) and oropharyngeal anaerobes. The gold standard for diagnosis
is contrast CT. The therapeutic approach depends on the clinic. Medical therapy can be
attempted in case of clinical stability and small size, setting intravenous antibiotic therapy
with a third-generation cephalosporin associated with ampicillin-sulbactam or clindamycin.
If there is no clinical improvement within 24-48 hours - or in the first instance
in case of respiratory distress or abscess greater than or equal to 2.5 cm2 in two-dimensional
projection - the surgical approach should be considered.
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Corrispondenza: luca.bernardini10@studio.unibo.it