The Soft-Tissue Lateral neck Film
• Approach– alignment
– bones -- vertebral bodies
– cartilage -- disc spaces
– C1 and C2
– positioning of the neck
– pre-vertebral space
– epiglottis
– subglottic space
• Needs to be in extension
• preferably at end-inspiration
Retropharyngeal abcess
• Micro– GAS, staph aureus,
anaerobes
• Complications– UA obstruction
– pus or secretion aspiration
– mediastinitis
– sepsis
– dehydration
Epiglottitis:Xray appearance
• ‘thumb-like’ appearance of epiglottis
• thickened aryepiglottis folds
• loss of normal pre-epiglottic (vallecular) space
Epiglottits
• Management– minimal agitation
– airway maintenance
– IV antibiotics
– IV hydration
– analgesia
– blood and epiglottic cultures
• Micro– staph. Aureus and GAS
most common
– also strep. pnemoniae
– Hib prior to vaccination
Croup (laryngotracheobronchitis)
• Most common upper airway obstruction in children, peak at 2 yrs
• Parainfluenza types 1 and 2, influenza A and B, rhinovirus
• edema of subglottic space
• worse during late night and early morning
Bacterial Tracheitis
• Rare complication of viral croup
• 6mo – 8yrs, mean age 5 yrs
• S. aureus, S. pneumo, Group A strep, H. flu, M. catarrhalis
• Best diagnosed by bronchoscopy – thick inflammatory exudate with sloughed mucosa in lumen
• Lateral neck x ray: hazy tracheal air column with luminal soft tissue irregularities
• 55 - 80% patients require intubation +/or tracheostomy
• Cefuroxime 50mg/kg IV Q8H +/- endotracheal suctioning prn