Peds Soft Tissue Neck Xrays Survival guide

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

Retropharyngeal abcess Micro –GAS, staph aureus, anaerobes Complications –UA obstruction –pus or secretion aspiration –mediastinitis –sepsis –dehydration

Epiglottitis: Xray appearance ‘thumb-like’ appearance of epiglottis thickened aryepiglottis folds loss of normal pre-epiglottic (vallecular) space

Normal epiglottis

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

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 Complications…?

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 % patients require intubation +/or tracheostomy Cefuroxime 50mg/kg IV Q8H +/- endotracheal suctioning prn