peds soft tissue neck xrays
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Survival guide. Peds Soft Tissue Neck Xrays. 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.

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Presentation Transcript
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

The Soft-Tissue Lateral neck Film
retropharyngeal abcess
Micro

GAS, staph aureus, anaerobes

Complications

UA obstruction

pus or secretion aspiration

mediastinitis

sepsis

dehydration

Retropharyngeal abcess
epiglottitis xray appearance
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

Epiglottits
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 (laryngotracheobronchitis)
bacterial tracheitis
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
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