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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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Peds Soft Tissue Neck Xrays

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Peds soft tissue neck xrays l.jpg

Survival guide

Peds Soft Tissue Neck Xrays


The soft tissue lateral neck film l.jpg

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


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Micro

GAS, staph aureus, anaerobes

Complications

UA obstruction

pus or secretion aspiration

mediastinitis

sepsis

dehydration

Retropharyngeal abcess


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Epiglottitis:Xray appearance

  • ‘thumb-like’ appearance of epiglottis

  • thickened aryepiglottis folds

  • loss of normal pre-epiglottic (vallecular) space


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Normal epiglottis


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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


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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)


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Croup Complications…?


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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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