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Lateral Neck X-Ray

Lateral Neck X-Ray. Soft Tissues Mark Bromley PGY4 November 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

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Lateral Neck X-Ray

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  1. Lateral Neck X-Ray Soft Tissues Mark Bromley PGY4 November 19, 2009

  2. Outline • Relevant Anatomy • Cases • Epiglottitis • Retropharyngeal Abscess • Bacterial Tracheitis • Croup • FB • Test Characteristics

  3. Case 1 4 year old male Inspiratorystridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

  4. When to order films… something else Sub-acute presentation Diagnosis is unclear Impending airway embarrassment

  5. Epiglottitis 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 OtolaryngolClin 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. • Enlarged epiglottis • Loss of valecular airspace • Thickened aryepiglotic folds • Distended hypopharynx • Straightening of the cervical spine • Sensitivity (38-88%) • Specificity (78%)

  6. Case 1 4 year old male Inspiratorystridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

  7. 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

  8. False Pre-vertebral Swelling Oblique lateral Neck flexion Crying

  9. Case 1 4 year old male Inspiratorystridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

  10. Case 1 3 year old male Inspiratorystridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

  11. Case 1 4 year old male Inspiratorystridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

  12. Foreign Body • Visualization of radiopaque FB • Widened pre-vertebral shadow • Loss of lordosis • Location • Esophagus – coronal plane • Trachea – sagittal plane (best seen on lateral)

  13. Test Characteristics

  14. Questions? Thank You!

  15. Triple blinded prospective study • 100 elective surgery patients • Lateral neck x-ray compared with Mallampati • Anesthesiologist gold standard (grade III or IV) • Results • Mallampatisens: 26% spec: 100% • Lateral neck film: sens: 100% spec:100%

  16. 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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