Snap Shot A 5-year-old boy presents to the ED with fever, neck pain, drooling and a muffled voice. On physical exam, cervical lymphadenopathy and a posterior pharyngeal wall mass is noted. Introduction Infection of the retropharyngeal space Most commonly affects children 6 months to 6 years Causitive organisms Group A strep S. aureus Bacteroides Presentation Symptoms fever neck pain patients prefer not moving the neck (it is painful to do so) drooling Physical exam cervical lymphadenopathy lateral neck mass Evaluation Lateral neck xray soft tissue plane greater than 50% of width of vertebral bodies Contrast CT Treatment Operative incision and drainage Pharmacologic antibiotics Complications Spread of infection into the mediastinum