June 2022: A Palpable Lump in The Neck

​“Wow! You don't see that that very often anymore. Why did you get a soft tissue lateral?"My colleague had a preschool girl with a 101°F temperature and a palpable lump laterally in her neck. I understood instantly. Our community place does not admit children, so identifying sick children is of prime importance. Transfers take time. A soft tissue lateral neck may be reassuring or not.I always evaluate the epiglottis and the retropharyngeal soft tissue when using soft tissue lateral neck x-rays to look for infection. Findings are nowhere near as common as during my training more than 30 years ago because of vaccines, but it is still almost immediate.The vallecula visually pops out in this child, making the thin epiglottis easy to find. The retropharyngeal soft tissue, on the other hand, appears prominent. The width should be checked at C2 and C6 (from the anterior aspect of the vertebra to the posterior line of the airway). The distance should be less than 7 mm at C2, and the distance should be less than 14 mm at C6 in children under 15. To guestimate, the retropharyngeal tissue should be less than half of the corresponding vertebral body.The child's neck in a more flexed position will make the tissue appear wider, and the image is better during inspiration. Still, assume this is abnormal until proven otherwise if the retropharyngeal space is widened. The risk in this area is high.Tip to Remember: The inability or refusal to extend the neck, particularly whe...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs