child with a retropharyngeal abscess who presents with a high fever, toxic appearance, and torticollis is sometimes incorrectly suspected to have meningitis A soft tissue lateral neck radiographic examination may demonstrate the lesion, whereas direct visualization is often impossible Unfortunately, flexion (even limited) of the neck during the radiograph may cause a buckling of the retropharyngeal tissues that resembles a purulent collection The clinician must insist on a radiograph with the neck fully extended before hazarding an interpretation If the diagnosis remains uncertain despite adequate radiographs, a computed tomography (CT) scan with intravenous contrast should be obtained TABLE 74.2 COMMON CAUSES OF SORE THROAT Infectious pharyngitis Respiratory viruses Group A streptococci Epstein–Barr virus Irritative pharyngitis Forced hot air heating TABLE 74.3 LIFE-THREATENING CAUSES OF SORE THROAT Retropharyngeal and lateral pharyngeal abscesses Epiglottitis Tonsillar hypertrophy (severe) with infectious mononucleosis Diphtheria Peritonsillar abscess Lemierre syndrome Lateral pharyngeal abscesses manifest in a fashion similar to retropharyngeal infections but occur less often High fever is a common symptom, and both trismus and swelling below the mandible may be seen Lateral neck radiographs are often unrevealing, with no appreciable thickening in the prevertebral space A CT scan helps to confirm the diagnosis The Children’s Hospital of Philadelphia Clinical Pathway