clinically i treated this kisd for croup with racemic epi and steroids. he did well and went home. to me the lateral x-ray looked close to the upper limits of normal.
the question i had is what is normal preverterbaral soft tissue measurments for kids? i learned that at 66 it should not me greater then the diameter then the verterbral body. on this kids x-ray it lookd that that was the case. you can see in the attached xray with the red line representing the diamterer of c6. however, the xray does not look like a good study becuase his neck is not extended:
see below from up to date.
"Plain radiographs – A lateral neck radiograph may be helpful in delineating retropharyngeal infection. Proper technique is critical to appropriate interpretation since false-positive studies are common. To avoid a false thickening of the retropharyngeal space, the film should be a perfect lateral obtained during inspiration with the neck held in normal extension [1,25,26]. False thickening of the retropharyngeal space also may be caused by crying, particularly in infants."
i found varying recomendations and numbers. see below and to attahched articles. my initial conclusion is that there is not nessessarly a hard set absolute minimum number to memorize. i wanted to know what you guys thought and maybe what Dr. Izsak thought.
Journal of Pediatric Orthopaedics:
April/May 2012 - Volume 32 - Issue 3 - p 249–252
doi: 10.1097/BPO.0b013e31824b2811
Trauma
Measurement of Prevertebral Cervical Soft Tissue Thickness on Lateral Digital Radiographs
Douglas, Tania S. PhD*; Gresak, Lara K. MBChB*; Koen, Nastassja MBChB*; Fenton-Muir, Naomi BTech*; van As, Arjan B. PhD†,‡; Pitcher, Richard D. FCR§
AbstractBackground: Widening of the prevertebral soft tissues is one of several significant indirect signs of cervical spine trauma. This paper provides pediatric radiographic reference measurements for prevertebral soft tissues at C2 and C6, and for the ratio of soft tissue to vertebral width at C6.
Methods: We reviewed 327 radiographs of consecutive patients under 14 years of age presenting at a trauma unit and obtained the relevant measurements using a software tool. Patients included in the study had no clinical features of cervical spine injury. Interobserver reliability of the measurements was assessed using the intraclass correlation coefficient of reliability. The effect of age category on the measurements was tested.
Results: Interobserver reliability was high for all measurements. The mean soft tissue width at C6 was significantly different across 3 age categories, whereas there was no significant difference for the soft tissue at C2 or the C6 ratio. The highest C2 soft tissue measurement was 10.6 mm, whereas the mean was 4.3 mm. The highest ratio at C6 was 1.2, with a mean ratio of 0.69.
Conclusions and Clinical Relevance: We present prevertebral soft tissue measurements from a larger sample of subjects than published previously, which allows our values to be used with more confidence as a tool in screening for cervical spine injury.
Attachments:
PVST1.pdf (595.28 KB)
pvst2.pdf (155.88 KB)
