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The Lateral Neck
Croup
- Soft tissue measurements on the lateral neck image
- At C3: <3 mm (less than 1/3 AP diameter)
- At C6: < the AP width of C6 vertebral body
- Retropharyngeal Space
- Contains lymphatics that drain
- Nasopharynx
- Adenoids
- Posterior nasal sinuses
- These chains atrophy after age 4
- Retropharyngeal abscess
- Almost all occur before age 6
- 50% between 6-12 months
- Most common pathogens are
- Staph aureus
- Group A Beta hemolytic Strep
- Hemophilus
- Clinically
- Prodromal nasopharyngitis
- Severe throat pain with drooling
- Dysphagia
- Hyperextension of the head
- “Hot potato” muffled voice
- In adults, usually 2° trauma to oropharynx
- Retropharyngeal perforation
- Causes
- Trauma to esophagus or trachea
- Penetrating injuries from weapons
- Perforation from within
- Chicken bone
- Mediastinal emphysema tracking into neck
- Retropharyngeal abscess 2° gas-forming organism
- Imaging findings of retropharyngeal perforation
- Streaks of air in soft tissues of neck
- Anterior displacement of pharynx
- Associated pneumothorax possible
- Cervical or mediastinal air seen in 60% of cases of ruptured esophagus
- Upper airway infections-The Big Two
- Croup
- Laryngeotracheobronchitis
- Usually viral
- May be difficult to distinguish from early retropharyngeal abscess
- Occurs at age 6 months to 2 years
- Younger than epiglottitis
- The three major findings of croup
- Distension of the hypopharynx
- Distension of the laryngeal ventricle
- Haziness or narrowing of subglottic space
- Epiglottitis
- Most commonly H. flu type B
- Peak incidence now closer to 6-7 years
- Croup occurs from 6 months to 2 years
- Lateral radiograph -- erect position only
- Supine position may close off airway
- Imaging findings
- Epiglottis is enlarged
- Appears thumb-like
- Aryepiglottic folds are thickened
- Pre-epiglottic space (vallecula) is smaller than normal
- In many cases, it’s obliterated
- Impacted esophageal foreign bodies
- Food or true foreign bodies
- Chicken bones (opaque), fish bones (non-opaque)
- Coins, toy trucks
- Most often they impact just below cricopharyngeous (70%)
- Another 20% impact at the level of the aortic arch
- Another 10% at EG junction
- Once past the esophagus, most foreign bodies will pass through the GI tract
- Clinical findings of an impacted esophageal foreign body
- Dysphagia and odynophagia most commonly
- Even if FB passes, many complain of pain referable to cervical esophagus
- Always check for lead lines in children
- Chicken bones are usually opaque
- Fish bones contain less calcium and usually are not
- Plain films usually do not demonstrate the FB but are still obtained first
- If negative, then either contrast esophagram or CT if high index of suspicion
- Treatment
- Removal is most often performed using endoscopy
- Temporization and surgery are other options
- An ingested button battery lodged in esophagus must be removed immediately
- Complications of an impacted foreign body
- Perforation
- Longer the FB remains impacted (>24hrs), higher incidence of perforation
- Stricture
- Diverticulum formation
Croup. Soft tissue lateral neck demonstrates a dilated hypopharynx (red arrow),
dilatation of the laryngeal ventricle (white arrow) and narrowing of the
subglottic trachea (blue arrow).
For this same photo without arrows, click here
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