Radiographic and Other Studies

1. Neck x-ray. Widening of prevertebral soft tissue space may be seen with retropharyngeal abscess. Width of prevertebral soft tissue space at fourth vertebrae should be less than half the width of vertebral body. Be sure patient's neck is in full extension for lateral neck film to avoid an increase in false-positive readings for retropharyngeal abscesses. Neck films can also identify the so-called thumbprint sign of an edematous epiglottis in epiglottitis and "shaggy-looking" trachea in bacterial tracheitis.

2. CT scan of neck. Diagnostic test of choice for retropharyngeal and lateral neck abscesses.

V. Plan. Tempo of diagnostic evaluation and treatment should be dictated by severity of patient's illness. If clinician suspects epiglottitis or if patient is in severe respiratory distress, do not compromise airway by examining oropharynx and do not send patient for radiographs before securing airway. Patients with significant respiratory distress regardless of cause may need endotracheal intubation.

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