Imaging Case of the Week 163 Answer

The lateral neck x-ray has two findings. The epiglottis appears enlarged with a positive thumbprint sign. There also appears to be a widened prevertebral soft tissue space anterior to C3-C4. The prevertebral space measures 11 mm in front of C3 and 14 mm in front of C4. Is it epiglottitis or is it a retropharyngeal abscess?

Lateral soft tissue neck xray

This patient went on to have a CT scan of the neck, which actually showed a retropharyngeal collection extending from C2 down to C6 with a cranio-caudal distance of 7.5cm.

Retropharyngeal abscess

There was no enlargement of the epiglottis on the CT scan.

This patient was commenced on broad spectrum IV antibiotics and admitted under an ENT specialist.

Normal prevertebral space in adults should measure less than 7mm anterior to C2/C3 and less than 21mm anterior to C6/C7 (radiopaedia).