A 3-year-old child presents with fever, stiff neck, and dysphagia. A lateral neck X-ray is obtained to evaluate for retropharyngeal abscess. What is the radiological criterion for a positive finding at the level of C2?

• A Air-fluid level at the C5-C6 level
• B Prevertebral soft tissue width less than 5 mm
• C Anterior wedging of the C2 vertebral body
• D Prevertebral soft tissue width greater than 7 mm ✓

Explanation

On a lateral neck radiograph, the prevertebral soft tissue space should normally be narrow. At the level of C2, a width greater than 7 mm is considered pathological and suggests a retropharyngeal abscess or hematoma. At C6, the width should not exceed 22 mm or 50% of the vertebral body width. Anterior wedging indicates trauma, and an air-fluid level is more typical of Zenker diverticulum or esophageal pathology.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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