Empyema developing from retropharyngeal abscess is a rare complication. Two infants with clinical symptomatology and initial chest radiographic findings of pleural fluid which suggested the possibility of retropharyngeal abscess are described. A child with submandibular and cervical abscesses is also reported; pleural fluid and mediastinal abscess developed less than 24 h after admission. Pathological processes in the neck can spread into the chest or conversely, either by direct continuity or by dissection through the fascial planes enveloping the cervical compartments. The middle or visceral space which is in direct continuity with the mediastinum is generally the area in which cervicothoracic disease inter-relates.