The soft tissue neck x ray is a very important and useful tool in a variety of clinical situations. X rays are used to make images of the internal tissues, bones and organs of the body on film by using invisible electromagnetic energy beams. For x rays to be made, external radiation must be used to produce images of the body internal organs and structures for diagnostic purposes.
X rays uses electromagnetic beams to pass through the body tissues to specially treated plates, these plates are similar to the film used in camera, and a negative type of picture is made. However, digital media and computers are used instead of films.
The soft tissue neck X ray can show structures like the adenoids, vocal cords, trachea, tonsils and the epiglottis (the flap of tissue that covers your windpipe when you swallow) which are nearby. Bones and other dense structures can appear white on x rays because they only allow little radiation to pass through them to expose the film on the other side. However, soft tissues can allow more radiation to pass through them as they are less dense. Soft tissues are less dense and will appear dark gray on the X ray image.
Soft tissues include:
- Blood vessels
SOFT TISSUE NECK X RAY
The soft-tissue neck x ray is a very important and useful tool in a variety of clinical situations. It uses radiation in small doses to construct images of the soft tissues in the neck. The image can show structures in the neck like the soft tissue of the vertebrae, vertebrae (the neck bones), the adenoids and tonsils in case they are enlarged. It can also show part of the trachea, the nasal and oral passage, the nasopharynx (where these two passageways meet), and the epiglottis (a flap that covers the trachea when you swallow).
Soft tissue neck X ray relies on differentiation of adjacent structures using four basic tissue densities: air, fat, water (which includes soft tissues, both solid organs such as muscle and fluids such as blood), and bone, sometimes called metal density (Radiology Key). When a neck x ray is done for the soft tissues, one picture is usually taken from the lateral (side) view. An additional picture from the front may also be taken.
The lateral view of soft tissue neck x ray will normally show:
- The base of tongue
- Vallecula – The channel that joins the base of the tongue to the epiglottis.
- Hyoid bone – A bone in the neck that is u-shaped and supports the tongue.
- Epiglottis and aryepiglottic folds
- Arytenoids – Cartilages that are fixed to the vocal cords.
- False and true cords with ventricle in between them
- Thyroid and cricoid cartilages
- Subglottic space and trachea
- Prevertebral soft tissues
- Cervical spine
- Pretracheal soft tissues and thyroid
IMPORTANCE OF LATERAL VIEW
- The narrowing of the multiple airways especially the upper, medically known as laryngeal stenosis
Compression of trachea by thyroid or retropharyngeal masses
Pus in the back of the throat (Retropharyngeal abscess)
- The presence of foreign bodies in the larynx, pharynx and upper oesophagus and to differentiate a foreign body of the airway from that of the food passage.
- Acute epiglottitis (Thumb sign)
- Position of tracheostomy tube, T-tube or laryngeal stent
- Fractures or injuries to the larynx, hyoid bone and their displacement. Caries of cervical spine, associated with pus in the back of the throat or a bony growth in cervical vertebrae or injuries of spine.
Soft tissue neck X ray can also be taken from the front to the back, this is called anteroposterior (AP) view as opposed to the lateral view that takes images from the side. Anteroposterior view is used when the patient is too unwell to stand or leave the bed. The following images from Radiology Key show the lateral and anteroposterior view of a soft tissues neck x ray and some health issues.
This is a soft-tissue neck x ray image of an anterior–posterior (AP) (A) and a lateral (B) x ray of the neck. When this image is compared to a cervical spine x ray, these images are underexposed deliberately to allow the soft tissues to be examined.
The retropharyngeal space is dramatically wide with visible air and is swerving the airway forward. Classically, soft-tissue neck x ray that has the setting of retropharyngeal abscess or pus may also reveal an air–fluid level in the retropharyngeal space which is not present in this image. B, Normal soft-tissue x ray is shown for comparison. The patient was intubated and ultimately taken to the operating room for surgical drainage, where the abscess presence was confirmed.
The images are from a 19-month-old, fully immunized boy who has acute onset of stridor (a high-pitched noise that comes with breathing) but without fever. The patient’s mother was unsure if he had ingested a foreign body causing this, and x rays of the soft tissues of the neck and chest were obtained.
A, The anterior–posterior soft tissue neck x ray shows an example of the long-segment subglottic narrowing typical of croup, which is called the “steeple sign” because it looks like a traditional peaked church steeple. B, The prevertebral soft tissues are normal, and the epiglottis appears normal on lateral x ray. The hypopharynx look ballooned, which is common in croup. X rays are not needed routinely to confirm croup when a typical history and physical is present.
This soft tissue neck x rays in this setting is done to rule out other causes, such as the presence of a foreign body aspiration or epiglottitis. The x ray was done for penetrating neck trauma. This 30-year-old man was shot although he ducked his head at the moment of the blast, and most of the shot impacted superficially in his scalp.
However, one pellet entered the mental vertex of his mandible and got lodged in the anterolateral neck. A, Anterior–posterior view shows that the pellet is in the region of the carotid artery which is in lateral left neck. B, the lateral x-ray combined with the AP view shows the pellet is not thorough or deep.
IMPORTANCE OF ANTEROPOSTERIOR VIEW
1. The view is done to see if the trachea is compressed or displaced by lateral neck masses, e.g. thyroid tumors or enlargement.
2. It is also useful to differentiate a foreign body of larynx from that of oesophagus.
WHY DO YOU NEED NECK X-RAY
Soft tissue neck x ray is recommended to:
1. Shows signs of enlarged tissues such as adenoids and tonsils.
2. Help reveal conditions such as swollen epiglottis (epiglottitis) and swelling around the larynx known as croup.
3. Help diagnose and treat problems with soft tissues of the neck.
4. Help accurately diagnose infections of the throat, such as retropharyngeal abscess that occurs when pus collects at the back of the throat.
5. Reveals any abnormal masses in the neck, such as cysts, tumors, and accidentally ingested/ inhaled foreign objects (e.g., fishbone) lodged in the airway.
Soft tissue neck x ray is also used to check for the following:
1. Fractured or broken bones
2. Osteoporosis (thinning of the neck bones)
3. Severe wear on the disks and joints of your neck (cervical spondylosis)
4. Dislocation (joints that are pushed out of their normal position)
5. Bone spurs (abnormal growths on the neck bones)
6. Spinal deformities
7. Car accidents, especially rear-impact collisions
8. Nerve pinch injury
WHAT TO EXPECT DURING A SOFT TISSUE NECK X RAY
The soft tissue neck x-ray can be done while the patient it sitting, standing or lying down, this depends on the condition of the patient and why the x-ray is needed. An x-ray procedure can take at least 15 to 50 minutes although the x-ray radiation is done within seconds. It is also painless unless the patient has injury in the neck region.
The position of the patient can be changed by the technician to get precise and accurate images. While the x-ray is being taken, the patient will be asked to hold their breath and remain still for a few seconds and the neck is to be kept still to prevent the image from being blur or the procedure will be redone.
After the soft tissue neck x ray, the technician will study the image and report back to your doctor, your doctor will discuss the results with you and explain what they mean. The results of the soft tissue neck x ray will also be used to make diagnostic and treatment decisions.
HOW TO PREPARE FOR THE SOFT TISSUE NECK X RAY
There are few steps to take although the procedure does not require special preparation. No jewelry, glasses, and metallic objects should not be worn, this is because metal can interfere with the X-ray equipment. You should tell your doctor if you are pregnant or chances of you being pregnant as x-rays are avoided during this period.
An x-ray uses electromagnetic radiation to make images of the body internal tissues, structures and organs. You should let your doctor know about your medical history if you have had an x-ray. Soft tissues neck x ray uses radiation in small doses to construct images of the soft tissues in the neck.
X-ray is a painless procedure that has no side effects. You can discuss with your doctor to explain the procedure especially if you are scared.