Differential Diagnosis

  • Complication of asthma
  • Mediastinitis
  • Retropharyngeal air
X-ray of neck with arrows indicating issue


This patient has retropharyngeal air, which is seen as a linear collection of gas paralleling the spine just posterior to the airway. Typical causes include surgery, trauma, retropharyngeal abscess, bronchial asthma, pneumomediastinum, physical exertion, forced swallowing, or any behavior producing instant positive pressure in the upper airway.

Learnings/What to Look for

  • Clinical symptoms vary depending on the involved confined space—from mild sore throat to acute airway obstruction
  • Retropharyngeal air can be a complication of asthma
  • In the absence of physical trauma, cough-inducing illness or environmental exposures, probe for participation in recent shouting, screaming or extreme use of the larynx

Pearls for Urgent Care Management

  • If mild, this condition is self-limiting and requires only supportive care
  • If severe, this condition can lead to airway compromise necessitating invasive supportive airway maneuvers

Acknowledgment: Images and case presented by Experity Teleradiology (www.experityhealth.com/teleradiology).

Neck Pain in a 17-Year-Old
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