A 3-year-old presents with high fever, sore throat, drooling, muffled voice, and torticollis. Examination shows bulging of the posterior pharyngeal wall. Lateral neck radiograph taken during inspiration shows prevertebral soft tissue measuring 9 mm anterior to the body of C2. What does this radiographic finding indicate in a young child?

• A Normal prevertebral soft tissue thickness for age
• B Retropharyngeal hematoma from birth trauma
• C Enlarged lingual tonsil displacing the airway forward
• D Retropharyngeal abscess, since soft tissue exceeding 7 mm at C2 is abnormal ✓

Explanation

Prevertebral soft tissue thickness should be less than 7 mm at the level of C2 in children; a measurement greater than 7 mm, especially with fever, torticollis, and a bulging pharyngeal wall, indicates retropharyngeal abscess rather than cellulitis. Contrast-enhanced CT is used to confirm a drainable collection. At the C6 level, up to 14 mm is acceptable in children younger than 15 years, so the C2 level is the discriminating measurement here.

Reference: Dhingra's Diseases of Ear, Nose and Throat, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.