Abstract
OBJECTIVE: To analyze the clinical characteristics and etiological spectrum of retropharyngeal space abnormalities in children, stratifying by age to improve diagnostic and therapeutic strategies. METHODS: We retrospectively analyzed the clinical data of 77 pediatric patients with imaging-confirmed retropharyngeal space abnormalities admitted to Wuhan Children's Hospital between January 2015 and March 2024. Patients were divided into two groups based on age: younger group (<6 years, n = 51) and older group (≥6 years, n = 26). Demographics, clinical presentations, imaging findings, etiologies, and treatment outcomes were compared between the groups using Chi-square or Fisher's exact tests for categorical data and independent samples t-tests for continuous data. RESULTS: The most common presenting symptoms were fever (49.4%) and neck mass (33.8%). The primary CT finding was retropharyngeal hypodensity or fluid collection (68.8%). No significant differences were observed in sex ratio, clinical symptoms, or imaging findings between the two age groups (p > 0.05). However, children <6 years old had a significantly higher rate of requiring transoral incision and drainage for retropharyngeal abscess (23.5% vs. 3.8%, p = 0.041). Etiologically, infectious diseases were significantly more prevalent in the older group (92.3% vs. 70.6%, p = 0.030), whereas congenital malformations were a more common underlying cause in the younger group, however, this trend did not reach statistical significance (p = 0.051). CONCLUSION: The etiology and management of pediatric retropharyngeal abnormalities are age-dependent; infectious causes dominate in children ≥6 years, while congenital malformations are key considerations in those <6 years, who are at higher risk for abscess formation requiring surgical intervention.