Neck Infection — Interpreting Lateral Neck — Clinical Pathway: Emergency

Deep Neck Space Infection Clinical Pathway — Emergency Department

Interpreting Lateral Neck

Review the considerations and anatomic areas listed below when interpreting the lateral neck. A prevertebral space of < 6 mm at the level of C3 is considered normal in children. Alternatively, in general, in infants between 2 and 5 years of age, the retropharyngeal soft tissues  (C1-C3) should be < 1/2 the AP length of C5 vertebral body, and the retrotracheal soft tissues (C4-C7) should be < the AP length of C5 vertebral body. In pediatric patients, widening of the prevertebral soft tissues can be a normal spurious finding that is related to expiration, crying, and/or suboptimal neck extension.​​

Review the Following Assessment
  • Image quality, neck position acceptable
  • Y/N
  • Retropharyngeal soft tissues thickened
  • Y/N
  • Abnormal air collections
  • Y/N
  • Adenoidal tissues: enlarged
  • Adenoidal tissues encroachment on nasopharynx
  • Nasopharynx patent
  • Y/N
  • Palatine tonsils: enlarged
  • Y/N
  • Epiglottis/aryepiglottic folds enlarged or thickened
  • Y/N
  • Larynx and proximal trachea
  • Normal/Abnormal
  • Mass or foreign body
  • Y/N
  • Superficial soft tissues and bony structures
  • Normal/Abnormal

Normal Upper Airway Anatomy—Infant

Normal upper airway anatomy

 

Normal upper airway anatomy

 
 

Retropharyngeal Cellulitis

Retropharyngeal Cellulitis

Retropharyngeal Abscess

Retropharyngeal Abscess

 

Images courtesy of Richard Markowitz, MD