OBJECTIVE: To report the case of a child with a retropharyngeal abscess complicated by carotid artery rupture. DESIGN: Descriptive case report. SETTING: Pediatric intensive care unit of a children's hospital. Patient: A 2-month old girl. INTERVENTION: Surgical ligation of the right common carotid artery was performed. MEASUREMENTS AND MAIN RESULTS: Carotid artery involvement is a rare but life-threatening complication of a retropharyngeal abscess. The child developed carotid arteritis, with pseudoaneurysm formation and acute rupture of the right carotid artery. Surgical ligation was performed, with no accompanying neurologic sequelae. A high index of suspicion is needed for the possibility of carotid space involvement if there is a delay in the resolution of symptoms, despite adequate treatment. CONCLUSION: If a retropharyngeal abscess extends into the carotid space or there is a slow resolution of symptoms, carotid artery involvement must be excluded.