Important structures to identify on a lateral X ray of the neck in children
• Assess the prevertebral soft tissues. Soft tissue swelling in this area could be due to retropharyngeal abscess, edema, hematoma, or soft tissue mass.
• The epiglottis should be triangular or flat in configuration, not bulbous or thumblike (which would indicate acute epiglottitis), and the aryepiglottic folds should not be thickened. Acute epiglottitis is related to inflammation of the epiglottis and aryepiglottic folds, usually due to Haemophilus influenzae infection, and most commonly occurs in children 3 to 6 years of age. This is a medical emergency due to acute airway obstruction and is treated with early intubation along with medical therapy
• Look for enlargement of the adenoidal tissue and tonsils.
• Assess the caliber of the trachea, which should not change abruptly.
• You may identify sloughed membranes within the tracheal lumen when bacterial tracheitis is present.
• A frontal radiograph is often useful in identifying croup, also known as acute laryngotracheobronchitis, which is due to a viral infection and characterized by symmetric subglottic narrowing that creates the “steeple” sign due to edema of the subglottic tissues