Retropharyngeal Air
Perforated Pharynx

• Causes
• Trauma to esophagus or trachea
• Penetrating injuries from weapons
• Perforation from within
• Chicken bone
• Mediastinal emphysema which tracks up into neck
• Retropharyngeal abscess from gas-forming organism
• Clinical findings
• Dysphagia
• Odynophagia
• Neck tenderness
• Crepitus
• Hematemesis
• Imaging findings
• Streaks of air in the soft tissues of the neck
• Anterior displacement of the pharynx
• Associated pneumothorax possible
• Cervical or mediastinal air is seen in 60% of cases of ruptured esophagus
• Treatment
• If hemodynamically stable, watch
• If hemodynamically unstable, emergent surgery

 
Perforated Pharynx. Streaky lucencies seen behind the airway represents
retropharyngeal air which in this case was secondary to
perforation of the cervical esophagus by a chicken bone.