The lateral neck x-ray shows a widened prevertebral space raising the possibility of a retro pharyngeal abscess. There are also enlarged tonsil and adenoid shadows, as annotated.

The patient was reviewed by an ENT specialist and admitted for treatment of severe adeno-tonsillitis.

The widened prevertebral soft tissue space in this case was attributed to technical issues, i.e. neck flexion and the child was crying at the time of image.

The optimal position to accurately assess the prevertebral soft tissue is to have the neck extended and the x-ray taken in end inspiration.

A sick child with suspected epiglottis or retro-pharyngeal abscess should never be sent for an x-ray. Agitation or getting the child to lie down will lead to airway compromise.

Reference: www.hawaii.edu, Radiology Cases in Pediatric Emergency Medicine.