Download - Lateral Neck X-Ray
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Lateral Neck X-RaySoft Tissues
Mark Bromley PGY4November 19, 2009
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Outline
Relevant Anatomy Cases
Epiglottitis Retropharyngeal Abscess Bacterial Tracheitis Croup FB
Test Characteristics
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Case 1
4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased
work of breathing
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When to order films…
Sub-acute presentation Diagnosis is unclear
Impending airway embarrassment something else
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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.
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Case 1
4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased
work of breathing
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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
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False Pre-vertebral Swelling
Oblique lateral Neck flexion Crying
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Case 1
4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased
work of breathing
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Case 1
3 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased
work of breathing
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Case 1
4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased
work of breathing
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Foreign Body
Visualization of radiopaque FB Widened pre-vertebral shadow Loss of lordosis Location
Esophagus – coronal plane Trachea – sagittal plane (best seen on lateral)
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Test Characteristics
Sensitivity SpecificityEpiglottitis 33-88% 78%Retropharyngeal abscess 80% 100%CroupForeign Body 84%
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Questions?Thank You!
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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%
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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
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