Neck Soft Tissue

Review article at Radiographics

Imaging Acute Airway Obstruction in Infants and Children

Do Not Miss

Normal Prevertebral Soft-Tissue Thickness

C1 8.5 mm
C2 6 mm
C3 7 mm
C6 18 mm
C7 18 mm

Increased Prevertebral Soft-Tissue

Epiglottitis

Exudative tracheitis

Increased density of the subglottic region as well as narrowing of the subglottic airway

Lateral Neck Radiograph

a = nasal cavity and paranasal sinuses
b = nasopharynx
c = hard palate
d = soft palate
e = buccal cavity
f = tongue
g = oropharynx
h = vallecula
i = piriform sinus
j = hyoid bone
k = larynx
l = epiglottis
m = true and false cords with laryngeal ventricle
n = trachea
o = prevertebral soft tissues at pharynx level
p = prevertebral soft tissues at cervical esophagus level
q = cervical spine

Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls

RadioGraphics 2017; 37:323–345

Sagittal anatomic diagram of neck.

N = nasopharynx (skull base to C1)

O = oropharynx (C2–C3)

H = hypopharynx (C3–C5)

L = larynx (C3–C6)

E = cervical esophagus (C6–D1)

T = trachea (C6–D4)

Foreign Bodies on Lateral Neck Radiographs in Adults: Imaging Findings and Common Pitfalls

RadioGraphics 2017; 37:323–345

Adenoidal hypertrophy (children)

The lateral neck x-ray is the main imaging study. The size of the adenoids is less of a consideration than the degree to which they encroach on the nasopharyngeal airway:

if no adenoidal tissue after age 6 months, suspect an immune deficiency
if enlarged adenoids persist well after childhood, suspect lymphatic malignancy

Radiopedia

Adenoidal and palatine tonsil enlargement

There is thickening of posterior naso-pharyngeal soft tissue which is indenting naso-pharyngeal air column on posterior aspect. Soft tissue shadow of soft palate and epiglottis is normal. Palatine tonsil shadow is enlarged at inferior aspect of soft palate. Tracheal air column is normal. Cervical spine and pre-vertebral soft tissue shadow appear normal.

Normal: AP

Normal: Lateral

Epiglottitis

Normal location of the epiglottis on lateral plain film of the neck.

Thumb sign (epiglottitis)

Croup

Steeple Sign

Although imaging findings are not required for the diagnosis, classic findings of narrowing of the subglottic airway and dilatation of the hypopharynx are supportive of the diagnosis.

Radiopaedia

Hypopharynx Dilatation

Imaging Acute Airway Obstruction in Infants and Children.pdf

Foreign Bodies on Lateral Neck Radiographs in Adults.pdf

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