Soft Tissue Neck Radiograph Research Articles

Updates in Diagnosis and Management of Croup

Croup is a common respiratory disease that affects 3% of children aged six months to three years. It represents 7% of annual hospital admissions for fever and/or acute respiratory disease in children under the age of five. Boys are more susceptible than girls to the condition, with an overall male/female predominance of 1.4/1. Viruses are detected in up to 80% of patients with croup with identifiable pathogens. The onset of symptoms is usually sudden and usually occurs at night: stridor, hoarse voice and respiratory distress are often seen due to upper airway obstruction. Croup is a clinical diagnosis, children with an uncertain diagnosis, anterior and lateral soft-tissue neck radiographs may be useful to support an alternative diagnosis. Management includes: general care, humidified air, heliox, corticosteroids, and epinephrine, Objective: This study aimed to discuss croup in terms of its etiology, pathogenesis, clinical features, diagnosis, assessment, and finally management.

Case report of acute epiglottitis in a 44-year-old man: a rare case

Background: Acute epiglottitis, also known as supraglottitis or supraglottic laryngitis, is an acute inflammation of the supraglottic area of the larynx. The diagnosis can be made based on clinical signs and symptoms as well as several investigations.Case Description: We reported a case of a 44-year-old man who presented to our emergency department and whose condition was ultimately diagnosed as epiglottitis. Indirect laryngoscopy and lateral soft tissue neck radiograph had an important role in determining the diagnosis. The patient was treated conservatively by giving a high dosed antibiotic, anti-inflammatory, and analgesic drugs.Conclusion: Acute epiglottitis can be a life-threatening condition because it can cause sudden upper airway obstruction. Therefore, management must be given quickly and precisely so as not to fall into a life-threatening condition.

Eagle syndrome masquerading as a chicken bone

This is a brief report of a 17-year-old male who presented to the emergency department with odynophagia and a foreign body sensation in the throat after choking on a chicken wing. A soft tissue neck radiograph was performed which revealed a 4.6-cm linear object in the vallecula read by the radiology department as a chicken bone. The otolaryngology team was consulted and performed a nasopharyngeal laryngoscopy which did not reveal a foreign body in the upper aerodigestive tract. On physical examination, the right tonsillar fossa was tender to palpation. Upon further review of the radiograph, the right stylohyoid ligament was noted to be elongated and calcified. Thereafter, the diagnosis of Eagle syndrome was made. This case provides an important teaching point for providers by pointing out a syndrome that can mimic other disease processes. In addition, it emphasizes the importance of providers reviewing their own films.

Initial radiographic tracheal ratio in predicting clinical outcomes in croup in children

Croup is the leading infectious disease resulting in pediatric upper airway obstruction. Our purpose is to analyze diverse features of neck radiographs could be seen as an objective tool to predict outcomes in patients with croup. One hundred and ninety-two patients were prospectively recruited in pediatric emergency department with diagnosis of croup. The initial Westley score (WS), presence of steeple sign, extent of narrowing, and narrowing ratio on soft tissue neck radiographs were determined before and after treatments. The extent of frontal narrowing, extent of lateral narrowing, frontal ratio (FR), and lateral ratio (LR) were investigated to predict clinical outcomes in patients with croup. The extent of frontal/lateral narrowing and LR had significant correlation with outpatient status. Almost 71% of patients with FR values below 0.23 stayed in the hospital longer, whereas nearly 98% of patients with FR vales above 0.65 could be discharged. About 85% of patients with LR below 0.45 hospitalized longer. The LR and FR were significantly correlated with the severity and admission rate in croup. The LR > 0.6 and FR > 0.65 may indicate low risk in patients with croup, whereas the FR < 0.23 or LR < 0.45 may indicate the need of stay in hospital for further treatment and monitor.

Utility of Soft Tissue Lateral Neck Radiographs in the Emergency Department: The 5-Year Experience of a Large Tertiary Care Pediatric Hospital.

Although retropharyngeal infection (RPI) may present with voice change, drooling, fever, and a toxic appearance, diagnosis based on symptoms alone is unreliable. As incidence is increasing in children and drug-resistant bacterial strains such as methicillin-resistant Staphylococcus aureus are becoming more common, we decided to assess the clinical utility of lateral neck radiography. The aim of this study was to review the experience of a large tertiary care pediatric emergency department (ED) in using lateral soft tissue neck radiographs in the diagnosis of suspected RPI. A retrospective analysis of all lateral soft tissue neck radiograph reports from 2011 to 2015 in conjunction with a review of patients' charts to describe clinical and laboratory findings, disposition, and final diagnosis was performed. Patients aged 31 days to 18 years who presented to the ED with suspicion of RPI were included. Review of 366 radiographic reports revealed that 46 were positive for RPI, 286 were negative, and 34 indeterminate. A final discharge diagnosis of RPI was made in 38 patients. Lateral neck radiographs had a sensitivity of 84.3% and a specificity of 93.7% for diagnosing RPI. In triage, most patients had no fever (264, 72.1%), stridor (356, 97%), drooling (348, 95%), or voice change (342, 93%). Surgical intervention occurred in 15 patients (39.5%) with a final diagnosis of RPI. Lateral neck radiography is useful for diagnosis of RPI in the ED with good sensitivity and specificity. Additional imaging is to be considered at the behest of physician's clinical judgment.

Missed hypopharyngeal foreign body: A case report

Foreign body ingestion has been a dilemma to many physicians including Otolaryngologist. Naturally, patient turns up at the out-patient department first prior to being referred to the otolaryngologist, which may lead to possibility of missed or neglected foreign body. We report a case of a missed foreign body which turned out to be his one-month dislodged denture. The unfortunate patient visited several different clinics within this one-month period, however he was dismissed as the lateral soft tissue neck radiograph done showed no abnormality.

PO-0284 Use Of Soft Tissue Neck Radiographs In Paediatric Acute Airway Obstructions: Current Perspective

Background Soft tissue neck radiographs (STNRs) have been recognised as a helpful tool to differentiate benign causes of acute upper airway obstructions (AUAO) from epiglottitis, retropharyngeal abscess or foreign body aspiration. Based on the frequency at which those life-threatening pathologies now occur, are STNRs still widely used and what is the impact of their clinical use? Methodology A retrospective study was conduct. Medical files from children aged 0–17 who had a STNR between January 1st 2010 and December 31st 2011 in a mid-size Canadian university paediatric hospital were reviewed. Patients were divided in 2 groups according to the conditions clinicians first suspected and compared the STNRs’ interpretations with Fisher exact test. Cases of epiglottitis and retropharyngeal abscess for the same period were reviewed. Results Among 520 STNRs identified, 88% intended to evaluate AUAO among children. Nearly all (99%) took place at the emergency room, with 73% of patients presenting with triage score 3 and above, and 49% necessitating admission. Most STNR were performed among males (67%) aged below 5 y.o. (66%; mode=1 y.o.). A life-threatening cause of AUAO was first suspected by clinicians among 40% of reviewed charts. Convincing radiologic signs of life-threatening pathologies were found in 40 children (9%). Overall, 2 cases of epiglottitis and 8 retropharyngeal abscesses were diagnosed during the study period. Conclusion STNR is a radiologic study that is frequently used among children. The current value of STNRs appears uncertain as few showed solid evidences that may modify how clinicians currently manage paediatric AUAO.

PO-0285 Identifying Radiologic Signs Of Life-threatening Causes Of Acute Upper Airway Obstruction In Children: Not That Easy!

Background Soft tissue neck radiographs (STNRs) are viewed as a helpful tool to investigate causes of acute upper airway obstructions (AUAO) among children. Some radiological findings guide clinicians identifying life-threatening causes of AUAO. Do the clinicians are skilled enough to recognise those signs? Methods A retrospective study was conduct and the medical files from children aged 0–17 who had a STNR between January 1st2010 and December 31st 2011 in a Canadian university paediatric hospital were reviewed. Those performed in an AUAO context were analysed. Identification by clinicians of significant findings on STNRs related to life-threatening causes of AUAO were compared to radiologists’ reports. Kappa coefficients were determined to describe inter-rater agreement on SNRT findings. The frequency at which SNRTs were described as technically inadequate by radiologists was also analysed. Results Among 457 STNRs, 11% (n = 52) showed findings of life-threatening causes of AUAO according to clinicians, compared to 17% (n = 77) according to radiologists (global sensibility=35%,specificity=93%; kappa=0.327). Sensibility and specificity differed according to signs evaluated: 26% and 97%, kappa=0.27 for swollen epiglottis/aryepiglottic oedema (n = 23 according to radiologists); 37% and 96%,kappa=0.37 for swelling of the retropharyngeal space (n = 38); 0% and 99% kappa=-0.01 for decrease tracheal diameter/deviation (n = 16); 100% and 99%, kappa=0.86 for the presence of a foreign body (n = 3). Moreover, 15% of SNRTs were described as technically inadequate by radiologists. Conclusion Identification of life-threatening causes of AUAO on STNRs appears quite challenging for clinicians. SNRTs are technically difficult to perform among children. Importance of STNRs need to be reassessed.

114: Use of Soft Tissue Neck Radiographs in Pediatric Acute Airway Obstructions: Current Perspective

114: Use of Soft Tissue Neck Radiographs in Pediatric Acute Airway Obstructions: Current Perspective

Analysing lateral soft tissue neck radiographs

A lateral soft tissue neck radiograph is a useful adjunct in diagnosing and managing the patient presenting with upper airway symptoms but is often inadequately reviewed. We present some common findings and robust systems to improve analysis of these radiographs.

The distended ventricle as a sign of bilateral abductor paralysis

uk. Stridor can prove to be challenging to the attending physician. Assessing and securing the obstructed airway is of paramount importance but is confidently undertaken only after an initial tentative diagnosis of the cause of stridor. Direct evaluation of the larynx by indirect laryngoscopy and fibreoptic laryngoscopy is the most informative examination— but may not be feasible (e.g., pediatric patients) and may not be available in the emergency situation. Sophisticated imaging, too, is often impossible due to movement artifact and the inadvisability of taking a stridulous patient to the scanner room. In many situations, the only evaluation that is immediately possible is radiography of the soft tissues of the neck. The usefulness of radiographs is currently restricted to indicating the diagnosis in cases of epiglottitis, croup, and foreign bodies of the laryngopharynx. This report describes an additional sign, the “distended ventricle” sign, which has been found useful in cases with bilateral vocal fold paralysis. Prior to the advent of computerized sectional imaging, the technique of visualizing the laryngeal ventricle was by sectional tomograms and by contrast laryngography. Assessment of the laryngeal ventricle was considered vital in the evaluation of cases of early laryngeal cancer with regard to their suitability for a partial laryngectomy. The specific maneuver to dilate the laryngeal ventricle and facilitate its imaging was by asking the patient to simulate “inspiratory phonation,” or to vocalize a “reverse E.” Since the stridor secondary to bilateral vocal fold paralysis (bilateral abductor paralysis) is indeed no different from “inspiratory phonation” or from voicing a “reverse E,” it is logical to assume that it would result in a dilated laryngeal ventricle. The soft tissue neck radiograph is routinely taken in inspiration and

Laryngotracheal paratubal air envelope: A useful sign in voice and airway reconstructive surgery

Aphonia, dysphonia, and laryngotracheal stenosis with upper airway compromise are diagnosed with increasing frequency. Endoscopic surgical reconstructive techniques accompanied by tracheal T-tube stenting successfully restore voice, airway function, and structure. Timing of tracheal T-tube removal remains controversial, particularly when the tip of the upper arm of the optimally sized T-tube is placed in a critical supraglottic position. The appearance of an air envelope, manifested as linear air densities between the outside wall of the T tube and the inside wall of the larynx and trachea, has proven to be a useful and reliable indicator of laryngotracheal structural integrity and functional stability. The paratubal air envelope sign is demonstrated by soft-tissue neck radiographs and delta scan topograms. This objective sign, videolaryngoscopy/stroboscopy, and clinical judgment combine to determine optimal timing for tracheal T-tube removal.