Retropharyngeal abscess is an uncommon entity that can have severe and even fatal complications if it is not identified and treated early. Clinical and radiologic findings must be considered together prior to surgical drainage of a suspected retropharyngeal abscess. Airway obstruction may require emergent surgical management with tracheotomy. We describe the case of a 22-year-old man with a massive retropharyngeal abscess that was caused by inadequate treatment of acute tonsillitis. He responded well to surgical drainage and empiric antibiotic therapy.