Radiographic and Other Studies

1. Lateral neck X-ray. Obtain during inspiration with patient's neck hyperextended. Widening of prevertebral soft tissues suggests retropharyngeal infection, although flexion and expiration may give false-positive results. An air-fluid level may be seen in some patients with retropharyngeal abscess.

2. Ultrasonography. Can be useful for soft, fluctuant masses (to differentiate lymphangiomas, hemangiomas, and lipomas) and suspected thyroglossal duct cyst (to identify presence or absence of normal thyroid tissue). Color-flow Doppler imaging is helpful to assess blood flow through certain lesions (eg, increased blood flow may be seen in tumoral lymphadenopathy). In fibromatosis coli, ultrasound will demonstrate an oval echogenic mass within the body of the sternocleidomastoid muscle.

3. CT scan of neck with contrast or MRI scan. May show inflammation in retropharyngeal cellulitis or a ring-enhancing abscess in patients with a cervical lymph node or retropharyn-geal abscess, and helpful in distinguishing cellulitis from abscess. CT or MRI scans typically are used when malignancy is suspected.

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