Peds Soft Tissue Neck XraysSurvival guide

The Soft-Tissue Lateral neck FilmApproachalignmentbones -- vertebral bodiescartilage -- disc spacesC1 and C2positioning of the neckpre-vertebral spaceepiglottissubglottic spaceNeeds to be in extensionpreferably at end-inspiration

Retropharyngeal abcessMicroGAS, staph aureus, anaerobesComplicationsUA obstructionpus or secretion aspirationmediastinitissepsisdehydration

Epiglottitis:Xray appearancethumb-like appearance of epiglottisthickened aryepiglottis foldsloss of normal pre-epiglottic (vallecular) space

Normal epiglottis

EpiglottitsManagementminimal agitationairway maintenanceIV antibioticsIV hydrationanalgesiablood and epiglottic cultures

Microstaph. Aureus and GAS most commonalso strep. pnemoniaeHib prior to vaccination

Croup (laryngotracheobronchitis)Most common upper airway obstruction in children, peak at 2 yrsParainfluenza types 1 and 2, influenza A and B, rhinovirusedema of subglottic spaceworse during late night and early morning

Croup Complications?

Bacterial TracheitisRare 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