Lateral Neck X-Ray Soft Tissues Mark Bromley PGY4 November 19, 2009
Mar 28, 2015
Lateral Neck X-Ray
Soft Tissues
Mark Bromley PGY4November 19, 2009
Outline
Relevant Anatomy
Cases Epiglottitis Retropharyngeal Abscess Bacterial Tracheitis Croup FB
Test Characteristics
Case 1
4 year old male
Inspiratory stridor
Unwell for past 24 hours
Mom found him in his room with increased work of breathing
When to order films…
Sub-acute presentation
Diagnosis is unclear
Impending airway embarrassment something else
Epiglottitis
Enlarged epiglottis
Loss of valecular airspace
Thickened aryepiglotic folds
Distended hypopharynx
Straightening of the cervical spine
Sensitivity (38-88%) Specificity (78%)
Croup and epiglottitis: a radiologic study. AU Stankiewicz JA; Bowes AK SO Laryngoscope 1985 Oct;95(10):1159-60.
Epiglottitis and croup. AU Sobol SE; Zapata S SO Otolaryngol Clin North Am. 2008 Jun;41(3):551-66, ix.
Adult epiglottitis: the Toronto Hospital experience. AU Solomon P; Weisbrod M; Irish JC; Gullane PJ SO J Otolaryngol. 1998 Dec;27(6):332-6.
Case 1
4 year old male
Inspiratory stridor
Unwell for past 24 hours
Mom found him in his room with increased work of breathing
Retropharyngeal Infection
Widened retropharyngeal space C2 – 7mm or C6 – 14mm (kids) C6 – 22mm (adults)
Reversal of normal cervical lordosis
Foreign body
Air-fluid level
Gas
False Pre-vertebral Swelling
Oblique lateral
Neck flexion
Crying
Case 1
4 year old male
Inspiratory stridor
Unwell for past 24 hours
Mom found him in his room with increased work of breathing
Case 1
3 year old male
Inspiratory stridor
Unwell for past 24 hours
Mom found him in his room with increased work of breathing
Case 1
4 year old male
Inspiratory stridor
Unwell for past 24 hours
Mom found him in his room with increased work of breathing
Foreign Body
Visualization of radiopaque FB
Widened pre-vertebral shadow
Loss of lordosis
Location Esophagus – coronal plane Trachea – sagittal plane (best seen on lateral)
Test Characteristics
Sensitivity Specificity
Epiglottitis 33-88% 78%
Retropharyngeal abscess 80% 100%
Croup
Foreign Body 84%
Questions?
Thank You!
Triple blinded prospective study
100 elective surgery patients
Lateral neck x-ray compared with Mallampati
Anesthesiologist gold standard (grade III or IV)
Results Mallampati sens: 26% spec: 100% Lateral neck film: sens: 100% spec:100%
Adult EpiglottitisRadiographic Criteria
Epiglottic height-to-width ratio >0.6
Epiglottic to C4 vertebral body width ratio >0.33
Aryepiglottic fold to C3 vertebral body width ratio >0.35
Prevertebral soft-tissue to C4 vertebral body width ratio >0.25
Hypopharyngeal airway to C4 vertebral body width ratio >1.5