Peds Soft Tissue Neck Xrays

• Survival guide

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

Normal epiglottis

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

Croup Complications…?

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