Fatal retropharyngeal abscess: a possible marker of inflicted injury in infancy and early childhood

Retropharyngeal abscesses are serious infections of the deep tissues of the neck associated with significant morbidity and mortality due to their proximity to vital structures. The most common age range is 2–4 years, with neonates accounting for approximately 10% of cases. The following report demonstrates possible forensic issues that may arise in such cases. Case Report: A 10-week-old infant was found dead in her father’s arms an hour after feeding. At autopsy death was due to a large retropharyngeal abscess with disseminated Streptococcus pneumoniae sepsis. Other findings at autopsy of bruising and multiple fractures of the ribs and limbs indicated inflicted injury; this raised the possibility that the abscess had arisen from forceful foreign body insertion into the pharynx. The mortality and complication rates of retropharyngeal abscess remain high even with the institution of appropriate treatment; however, the wide variety of presentations often causes delays in diagnosis and treatment. When found at autopsy in infants and children the possibility of inflicted injury should be considered.Angela Byramji, John D. Gilbert and Roger W. Byar