Lateral Neck X-ray Research Articles

The Validity of Lateral Neck X-Ray for the Diagnosis of Retropharyngeal Infection in Pediatric Patients

The Validity of Lateral Neck X-Ray for the Diagnosis of Retropharyngeal Infection in Pediatric Patients

Clinical and radiological profile of cervical spine injuries in maxillofacial trauma patients reporting to a tertiary trauma centre in central Kerala

The aim of the study was to determine the clinical and radiological profile of patients with cervical spine injuries in maxillofacial trauma patients following road traffic accidents in central Kerala. Percentage of cervical spine injuries associated with maxillofacial injuries, age and sex distribution, frequency of the type of cervical spine injury were studied. A descriptive cross sectional study was conducted on two hundred and fifty patients with maxillofacial trauma who reported to the Department Of Oral and Maxillofacial surgery, Government Dental College, Kottayam between July 2023 and June 2024 and who gave the consent for the study.Clinical evaluation of cervical spine was undertaken as the part of the initial assessment of all trauma patients. Neck pain was assessed with visual analog scale of 1-10 and altered sensations in upper limbs were evaluated. Lateral neck x-ray was taken to rule out cervical injury in all patients without C.T scan. The data was entered into MS excel spread sheet and analysed using SPSS version 20. Proportions were used to study categorical variables, mean and standard deviation were used for quantitative variables. Chi square test was used to test the difference in proportions of categorical variables. p values less than 0.05 was considered statistically significant in the data. The study has shown that there is a statistically significant occurrence of cervical spine injuries in maxillofacial trauma victims in road traffic accidents. The presence of maxillofacial trauma with cervical spine injury mandates prompt management with immediate reference to neurosurgeon to reduce morbidity.

A typical presentation of a laryngeal foreign body in an infant

Background: A 1-year-old boy presented with a one-day history of fever and cough, potentially linked to an episode of aspiration during homemade rice feeding. Following the incident, he refused to feed, displaying irritability. The detection of neutrophil leucocytosis and dehydration prompted IV antibiotics and fluid. Persistent symptoms led to a lateral neck x-ray, revealing a radiopaque material near the epiglottis. Fibre optic laryngoscopy identified a metallic wire lodged in the right arytenoid cartilage and posterior pharyngeal wall, possibly a fragment from a rice polishing machine. Extraction under general anaesthesia resulted in minimal mucosal injury, and the child quickly recovered postoperatively.Conclusion: This report serves as a reminder to consider foreign body ingestion in the differential diagnosis, particularly in cases with subtle or unrelated symptoms in the paediatric age group. The multidisciplinary approach emphasises prompt intervention to prevent life-threatening complications in paediatric patients. Furthermore, employing awake fibre-optic laryngoscopy in the context of a suspected respiratory tract infection to confirm the presence of a foreign body is considered a clinically safer approach than immediately resorting to examination under anaesthesia.

Peri-operative anaesthesia challenges in large anterior mediastinal mass - A case report

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected.Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.

Comparison of lateral neck X-ray to neck CT in patients with suspicious bone impaction: “Old habits die hard”

ObjectiveBone impaction (BI) is a common cause for emergency room visits. Among foreign bodies, fish bone is considered the most common. The sensitivity of symptoms in predicting BI is relatively low, making imaging a central tool to aid diagnosis. Current imaging practices include both neck plain film radiography and none-contrast CT scans of the neck. We evaluated the accuracy of neck plain film radiography and CT scans of the neck for the diagnosis of BI. MethodsRetrospective review of all patients who presented to the emergency room between 2009 and 2016 with a suspicious history of BI whom underwent plain film neck radiography or CT. All Images were reviewed by two neuro-radiologist blinded to the clinical symptoms and findings. Symptoms, clinical findings and images results were compared to the final diagnosis. Results89 patients (30.7%), out of 290 patients who presented with complaints of BI, were diagnosed with BI. Mean age was 44.7 years old. Plain film neck radiography failed to predict BI (sen. 14.4%, spe 89.8% accuracy 63.2%), neck CT has an improved accuracy and sensitivity in locating BI (sen. 83.3%, spe. 94.1% accuracy 92.5%). Interobserver agreement between the two neuro-radiologists was moderate (0.46) and substantial (0.77) in neck radiography and CT images, respectively. Neck radiography missed 60 (out of 61) oropharyngeal BI's. ConclusionNeck radiography has high inter-observer variability and low sensitivity for the diagnosis of BI. Neck CT should be the first imaging modality in patients with suspicious complaints for BI and negative physical exam.

Sudden hoarseness of voice in COVID-19 patient.

Sudden hoarseness of voice in COVID-19 patient.

Assessment of adenoid hypertrophy with clinical grading versus radiology and endoscopy- A cross-sectional study

Chronic adenoid hypertrophy is the most common presentation seeking medical advice in pediatric age group. Evaluation of adenoid enlargement is usually done clinically, but its reliability in young children is questionable. Although various diagnostic procedures have been proposed to diagnose adenoid hypertrophy, there is poor concordance on the ideal method by clinicians. The purpose of this study is to corroborate a clinical grading that could guide the clinicians in accurate diagnosis of adenoid hypertrophy and to warrant the cases needing adenoidectomy and to calibrate this clinical grading with endoscopic and x-ray findings.A cross-sectional study was conducted in a tertiary health care among 60 children aged between 3-14 years who presented with signs and symptoms of chronic adenoid hypertrophy are evaluated with clinical grading, endoscopy, lateral neck x-ray, and findings were documented. The proposed clinical grading comprised of nasal and paranasal symptoms, ear complaints, craniofacial abnormalities, and sleep disturbances.The statistical analysis was done with Pearsons Chi square test and the correlation between endoscopic and clinical grading is highly significant (p=0.0006), and there is also a strong correlation between radiological and endoscopic grading (p=0.0003), the correlation between clinical grading and radiological finding (p=0.04) was significant.Clinical grading was found to be a reliable parameter for assessment of the severity of adenoid hypertrophy. Though x-ray is a convenient procedure for diagnosing adenoid hypertrophy, it was found to be less accurate in assessing the clinical implications when compared to endoscopy.

An impacted coin in the esophagus: a cause of dysphagia in a child.

A 4-year-old female with no previous medical history presented to the Emergency Department complaining of difficulty in swallowing especially solid food for a duration of 4 days. This was accompanied by some painful swallowing whenever she attempted taking solid foods. She preferred taking liquids in all the four days. She had no cough, difficulty in breathing, chest pain, stridor, drooling or fever. Physical examination revealed relatively normal oral, neck, abdominal, respiratory and neurological examination. An anteroposterior chest X-rays (A) revealed a round opaque object and a lateral neck X-ray(B) showed a thin opaque object, presenting in a coronal plane, on the same level of the child’s esophagus. Our patient was taken to the emergency operating theatre for endoscopic removal of an esophageal foreign body under anesthesia. A coin was removed without any complications. Initial use of X-ray investigations is important for children with dysphagia before opting for invasive procedures. A coin in the esophagus lies in the coronal view, whereas when situated in the trachea it lies in the sagittal view.

Clinical Radiographic Predictors of Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea.

To determine if clinically acquired cephalometric measurements, specifically soft palate size, can predict hypoglossal nerve stimulation outcomes. Combined prospective cohort study and retrospective review. US sleep otolaryngology training program. Adults with obstructive sleep apnea and apneahypopnea index greater than 15 events/h who underwent hypoglossal nerve stimulation. Eligible subjects had diagnostic preoperative sleep studies and full-night efficacy postoperative studies for analysis. Lateral neck x-rays were obtained as part of routine clinical care and measured for key cephalometric variables by trained head and neck radiologists. Continuous variables were compared using the Student t test, while χ2 testing was used for categorical variables. Fifty-one patients met all study criteria. On average, patients were white, middle aged, and overweight. Following hypoglossal nerve stimulation, the overall cohort achieved a significant apnea-hypopnea index reduction from 36.7 events/h to 20.6 events/h (P < .01) and a response rate of 47% (defined as apnea-hypopnea index reduction >50% and apnea-hypopnea index <20 events/h). On average, therapy responders had significantly thinner soft palates than nonresponders (13.4 ± 3.8 mm vs 16.0 ± 3.4 mm, P = .045). Patient-specific anatomic factors, specifically soft palate thickness, may help identify optimal candidates for hypoglossal nerve stimulation. A larger, prospective study including both anatomic and physiologic variables is required to validate these findings.

Lateral neck X-ray provides a diagnostic clue in a child presenting with dyspnoea and stridor

Lateral neck X-ray provides a diagnostic clue in a child presenting with dyspnoea and stridor

Changes in Pharyngeal Width Over Time as an Indicator of Dysphagia in Stroke Patients.

ObjectiveTo verify the pharyngeal width at rest as a measurement that could be used to assess changes in the degree of dysphagia over time in stroke patients.MethodsIn a cohort of stroke patients, we performed serial measurements of the pharyngeal width at the midpoints of the second (C2) and third (C3) cervical vertebral bodies using lateral neck X-rays while the patients were at rest. The JOSCYL width, a parameter named after the first initial of each developers’ surname and defined as the average value of the upper and lower pharyngeal widths, was used to formulate the JOSCYL scale, which was calculated as the JOSCYL width × 100/neck circumference. All patients also underwent serial videofluoroscopic swallowing studies (VFSSs). The Spearman correlation analysis was used to detect correlations between the serial VFSS results, JOSCYL widths, and JOSCYL scale values.ResultsOver time, we observed significant positive and negative correlations of change in the JOSCYL width and scale with changes in the Penetration-Aspiration Scale and the Dysphagia Outcome and Severity Scale scores, respectively.ConclusionThe JOSCYL width and JOSCYL scale clearly reflected changes in dysphagia in stroke patients over time. These parameters may provide an easier method for evaluating whether post-stroke dysphagia has been alleviated.

Adenoid hypertrophy among school-aged Iraqi children, the effect of severity and duration on its co-morbidities

Adenoid hypertrophy is a common pediatrics health problem that usually results in several morbidities such as sleep disorder, adenoid facies, impaired physical growth, cardiac complications, glue ear and nocturnal enuresis. Patients and methods: Forty-two school-aged children were enrolled in this study (6-12 years old), thirty were male and twelve were female, all are suffering from chronic snoring. All of them were subjected to standard history and physical examination to the most related health problems such as assessment of physical growth, craniofacial malformation, associated tonsillar enlargement. Investigations were performed in the form of lateral neck X-ray and ECG for all of them. The study period was 9 months from 1st of March 2018 to the 1st of December 2018. Results: There was a significant association between a higher grade of disease and speech disorders, tonsillar hypertrophy, adenoid facies, recurrent otitis media, nocturnal enuresis, impaired school performance, physical growth impairment, apnea at sleep, day time drowsiness, ECG abnormalities and deglutition problems (P &lt; 0.05). The associated co-morbidities, namely Speech disorders, tonsillar hypertrophy, adenoid facies, recurrent otitis media, nocturnal enuresis, impaired school performance, impaired school performance, physical growth impairment, apnea at sleep, day time drowsiness, ECG abnormalities and deglutition problems, were significantly correlated to the longer duration of disease. Conclusion: Longer duration of disease and higher grade of adenoid hypertrophy are strongly correlated with disease complications and morbidities, hence early diagnosis and properly timed management is important to prevent these complications.

Lateral Soft Tissue Neck X-ray a Tool for the Otorhinolaryngology Surgeon

Background: Management of aerodigestive emergencies can prove a challenge especially in this sub-Saharan region where there is a dearth of specialized equipment. In some areas, a plain radiograph may be the only investigative tool readily available to the surgeon. It is routinely done in most of these cases. In our environment health care is often financed by the patients through out of pocket expenses since most do not have health insurance. Affordability of a particular treatment becomes paramount. This study, therefore, is aimed at assessing the use of lateral soft tissue neck X-ray and its reliability as a diagnostic tool in aerodigestive emergencies.&#x0D; Objective: To determine the relevance or effectiveness of plain radiograph of the lateral soft tissue neck in patients with upper aerodigestive emergencies and therefore its use as a tool to the otorhinolaryngology (ORL) surgeon as the first-line investigation in these patients.&#x0D; Patients and Methods: It is a prospective study of all patients that presented to the ENT surgery department of UPTH from April 2018 to April 2019 with upper aerodigestive emergencies. Patients who presented in the ENT clinic, accident and emergency department, children`s emergency wards and the clinics with upper aerodigestive emergencies were recruited in this study. All the patients had X-ray lateral soft tissue of the neck done on presentation and the results were then compared with the final operative findings in the operation theatre. Some patients had also chest radiograph done however; the diagnosis was done based on the lateral soft tissue neck finding. Patients that had radiologic investigation other than radiograph of the lateral soft tissue neck as the main investigative tool were excluded from the study. The radiologist opinion was obtained for all the radiographs as a routine. The results were analyzed using the SPSS 20 and presented in simple statistical tables.&#x0D; Results: Sixteen patients were studied. Males were 14(87.5%) while females were 2(12.5%). Age range was from 1.5 to 77 years with children comprising only 31.25% of the study population. The commonest presenting complaint was voice change 68.75%. Positive findings on the x-ray neck were seen as soft signs in 62.5% and radio-opacity in 18.75%. In n=14(87.5%) the lateral neck x-ray positive findings were corroborated by the operative findings. The tool has a specificity of 100% for both foreign body inhalation/ingestion and laryngeal tumour but the sensitivity of 80% in laryngeal tumours but 100% for the foreign body.&#x0D; Conclusion: Study concludes that lateral soft tissue neck x-ray was found to be a good and useful tool in the diagnosis of a good number of upper aerodigestive emergencies such as foreign body ingestion/inhalation and patients with upper airway obstruction caused by laryngeal tumours and some infective conditions such as a retropharyngeal abscess.

Features of course and surgical treatment of tonsillogenic neck phlegmons and mediastinitis

Background. The problem of adequate treatment for deep neck and mediastinal suppuration is one of the most difficult in surgery. It leads to such complications as mediastinitis, sepsis, arrosive bleeding, etc. The purpose was to investigate clinical, diagnostic and treatment features in patients with neck phlegmons and mediastinitis caused by pharyngeal suppurations. Materials and methods. The results of treatment of 31 patients with parapharyngeal phlegmons were presented. The average age of them was 48.24 ± 15.60 years, men were 18 (58 %), women — 13 (42 %). All persons suffered from severe endogenous intoxication. The time from the onset of the disease to surgery was about 4 days (from one to seven). Results. Most frequently, parapharyngeal suppuration was detected — in 16 (51.6 %) patients, then paratonsillar abscesses — in 11 (35.5 %), retropharyngeal suppurations — in 3 (9.7 %), and laryngeal cancer — in 1 (3.2 %). Lateral neck radiographs were performed in all patients preoperatively. Sensitivity of this investigation was 100 %. At the same time, chest X-ray to detect mediastinitis showed low rates of sensitivity — 60 %. Surgical approaches included extensive cervicotomy (often bilateral) and penetrative polydrainage of prevertebral space. Mediastinitis was found in 15 cases (48.4 %). It was enough to use blind drainage for upper posterior mediastinitis (11 cases, or 73.3 %). Right-sided thoracotomy was performed in one case of total posterior mediastinitis. Four patients died (13 %). Descending mediastinitis and sepsis were found in all lethal cases. Mortality rate in the group of patients with mediastinitis was 26.7 %. Conclusions. Neck phlegmons as a result of parapharyngeal suppuration are characterized by an aggressive course with significant endogenous intoxication and spread to the mediastinum in 48.4 % of cases with a lethality of 13 %. The lateral neck X-ray must be performed to all patients with suspicion of a deep neck phlegmon. In most cases (80 %), suppuration spreads from the parapharyngeal spaces to posterior mediastinum, which should be taken into account when opening purulent abscesses.

Role of Adenoid-Nasopharyngeal Ratio in Assessing Adenoid Hypertrophy.

Most of the time, pediatrician is the first to see children with adenotonsillar hypertrophy (AH) and they mostly rely on clinical assessment with or without some investigation to refer these children to otorhinolaryngologist. Numerous methods have been described for evaluation of AH, but many of these methods are not possible to follow in busy pediatric outpatient unit either because of lack of cooperation from child or due to limited availability of test or due to cost constraints. This study has been conducted to determine the diagnostic accuracy of lateral neck X-ray (LNX) for assessing AH and to assess the correlation between adenoid size in LNX and clinical symptoms in a pediatric unit. Prospective study conducted in Department of ENT, Pathmavathy Medical Foundation, Kollam, Kerala, India from January 2015 to March 2016. 60 consecutive children of both genders, between the age group of 5 to 14years, attending Department of Pediatrics with a provisional diagnosis of AH were included in the study. The symptom scores, radiographic ratio of adenoid to nasopharynx and endoscopic scorings were calculated. Lateral neck X-ray with calculation of adenoid-to-nasopharynx ratio is found to have significant correlation with patient reported symptoms and findings in nasal endoscopic examination (NE). LNX can be considered as a useful objective tool in evaluation of children with adenoid hypertrophy. Primary care physicians or pediatricians can confidently use lateral neck X-ray for making clinical decisions and can consider nasopharyngoscopy when clinical picture remains unclear or more evaluation is needed.

Woman Swallows a “Handful of Pills”

History of present illness: A 64-year-old female presented to the emergency department feeling like she had “pills stuck in [her] throat,” specifically calcium and a multivitamin, which she tried to relieve with drinking, eating and sticking two fingers down her throat. She was sitting upright, speaking in full sentences but had a hoarse voice. She was tolerating her secretions but had frothy sputum in the posterior oropharynx. Significant findings: Soft tissue lateral X-ray of neck was performed. The lateral soft tissue X-ray of the neck showed a metallic foreign body at the level cricoid. Discussion: Most swallowed foreign bodies enter the esophagus. Larger foreign bodies tend to obstruct proximally and may cause airway compromise in addition to esophageal trauma.1 Foreign bodies tend to lodge at areas of anatomic narrowing, most commonly the upper and lower esophageal sphincters, physiologic angulation, and areas of pathologic stricture.2,3 Ensuring airway patency and ability to manage secretions is paramount and any concern for compromise should prompt emergent consultation with otolaryngology and/or gastrointestinal. Determination of which service to consult should be made based on the suspected location of obstruction and associated symptoms. In addition to obtaining a complete history of the ingestion including type of foreign body, size, and shape, it is prudent to ask what measures, if any, the patient has already taken to remove the object.In this case, flexible fiberoptic laryngoscopy revealed swollen arytenoids and some small abrasions proximal to the vocal cords, which themselves appeared normal. She had copious secretions with no foreign bodies seen. On endoscopy, a metallic finger ring was found at the cricopharyngeus muscle along with non- obstructing laryngeal edema. The ring was removed with rat-toothed forceps. No pills were found. The patient had no recollection of swallowing the ring, but presumably, it slipped off her finger in the process of attempting to make herself vomit. After brief observation, she passed a bedside swallow assessment and was discharged in good condition. Repeat upper endoscopy 8 days later revealed a tortuous esophagus but was otherwise unremarkable. Topics: Foreign body, laryngoscopy, endoscopy, airway management.

It's a cod! Finding Nemo (impacted fishbone) in the emergency department

A 23-year-old woman presented to the emergency department (ED) with a sensation of a ‘fish bone’ stuck in her throat after eating cod. On physical examination, while she reported an...

Acute Retropharyngeal Abscess Masquerading as Meningitis

Retropharyngeal abscess is a potentially serious deep neck space infection occurring more frequently in children than in adults. The clinical picture of RPA is highly variable with paucity of physical findings. Prompt diagnosis of RPA especially in infants is mandatory to prevent potential fatal complications including airway obstruction. The diagnosis of RPA should be based on high index of clinical suspicion with supportive imaging studies like lateral X-ray of neck and CT. We present a case of acute retropharyngeal abscess which was initially misdiagnosed as meningitis and led to airway obstruction. This case is reported to create awareness among emergency physicians, paediatricians and otolaryngologists to have high index of suspicion in diagnosing RPA especially in infants.

Spontaneous Retropharyngeal and Mediastinal Emphysema.

A 14-year-old girl with no significant medical history presented at Emergency Department with sore throat and odynophagia after one episode of nonviolent coughing. She denied any respiratory distress, voice change, foreign body ingestion, retching, substance abuse, dental procedures, or trauma. She was afebrile with normal oxygen saturation and physical examination including the head and neck was unremarkable with the exception of bilateral neck crepitus without tenderness on palpation. Fiberoptic laryngoscopy revealed a patent laryngeal airway with normal vocal fold movement. Lateral neck X-ray demonstrated a linear air-column in the retropharyngeal space and computed tomography confirmed emphysema involving the retropharyngeal space and mediastinum with no evidence of fluid collection or abscess formation. Spontaneous retropharyngeal and mediastinal emphysema are clinical entities where free air is present within the confines of retropharyngeal space and mediastinum without obvious cause. It is benign and self-limited in nature and allows for conservative management. This case is presented with a review of literature.

Is That an Oesophageal Foreign Body I See?

The presence of an oesophageal foreign body is a medical emergency requiring urgent evaluation and treatment and in cases with complications such as migration of foreign body or oesophageal perforation, surgical intervention may be necessary. We present a case of a 23 year old Chinese female with no significant past medical history who presented to the emergency department with central chest discomfort for a week. She had throat discomfort prior which started after she accidentally swallowed a small piece of cockle shell while eating. CXR and lateral neck X-ray were done which did not reveal any abnormalities. A referral was made to the ENT team to rule out the possibility of a foreign body, and a nasoendoscopy was performed which did not reveal any abnormalities. In view of her persistent symptoms, a CT chest was performed which revealed a curvilinear radio dense opacity at the aortopulmonary window measuring 1.0cm, which is suspicious for a foreign body. The differential for a radio dense opacity in the aorto-pulmonary window is calcification of the ligamentum arteriosum, which was the final diagnosis after exclusion with further investigations inpatient.