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Thorax and Abdomen

5 Soft Tissue Neck

Anatomy

pharynx, larnyx, trachea, hyoid

Projections

AP Upper Airway

CR Location

72 inch SID. Position the patient in AP position, seated or standing, with midsaggital plane perpendicular to the IR. Direct the CR perpendicular to the level of C4 (top of IR at the level of the EAM). Depress the shoulders and elevate the chin. Expose during deep inspiration.

Evaluation Criteria

No motion, no rotation (sternoclavicular joints equidistant from spine).  Entire upper airway is visualized without superimposition of shoulders or chin.

Lateral Upper Airway

CR Location

72 inch SID. Position the patient in Left Lateral position, seated or standing, with midcoronal plane perpendicular to the IR. Direct the CR perpendicular to the level of C4 (top of IR at the level of the EAM). Chin should be extended slightly and shoulders depressed and pulled back to prevent superimposition.

Evaluation Criteria

No motion, no rotation (cervical spine demonstrated in true lateral). Entire upper airway should be visualized without superimposition of shoulders or chin.

Hows & Whys of Soft Tissue Neck Radiography

Epiglottitis is one of the most dangerous causes of acute upper airway obstruction in children and must be treated as an emergency. Symptoms of epiglottitis include acute respiratory obstruction, high fever, and dysphasia (difficulty swallowing).

The patient must remain in an upright position with the airway monitored at all times.  Perform a single lateral upright image of the patient’s nasopharynx without moving the patient’s head or neck.

Do not perform this exam without the physician present. Take care not to panic, agitate or make the child cry.

  • What are the indications for performing a soft tissue neck study?
    • Common reasons include stridor, suspected foreign body aspiration, or evaluation of upper airway pathology
  • Why should upper airway images be taken on full inspiration?
    • To maximize lung volume and demonstrate upper airway structures without superimposition.
  • How can you tell that an AP upper airway image is not rotated?
    • Sternoclavicular joints are equidistant from the center of the spine and clavicles are symmetrical.

 

License

Radiographic Procedures Review Guide Copyright © 2025 by Carla M. Allen and Taylor M. Otto. All Rights Reserved.