title: Cervical Prevertebral Soft Tissue Swelling in the Traumatized Patient: What is Normality in the Intubated Patient?
abstract: Interpretation of prevertebral soft tissue swelling is generally thought to be invalid in the presence of an endotracheal tube (ETT). There is however little scientific data to support this.We evaluate the prevertebral soft tissue swelling of 43 traumatized patients that have had an endotracheal tube (ETT) placed in the acute setting. A control group of 92 patients were also evaluated which had been subjected to acute trauma and no ETT. There was a significant increase in soft tissue swelling (p < 0.0001) found in the ETT group at the C2 level compared to the non-tube group. There was no significant difference between the two groups at the C4 and C6 levels.We feel that interpretation of prevertebral swelling in the traumatized patient at the C2 level is invalid in the presence of an ETT, and indeed is significantly increased after intubation despite no injury at this level. However, the interpretation of soft tissue swelling at and below C4 remains a useful tool in the evaluation of an occult cervical injury.
authors.affiliation: , 22 Ashley Road, London, N19 3AE, UK. dimascio@doctors.org.uk.
authors.forename: Livio
authors.initials: L
authors.lastname: Di Mascio
authors.affiliation: Department of Orthopaedics, Royal London Hospital, London, UK.
authors.forename: Algapan
authors.initials: A
authors.lastname: Sivaraman
keywords: Cervical trauma; Intubation; Prevertebral soft tissue swelling
references.citation: Skeletal Radiol. 2000 Jun;29(6):340-5
references.pmid: 10929416
references.citation: Radiographics. 1996 Nov;16(6):1307-18; discussion 1318-21
references.pmid: 8946537
references.citation: Clin Orthop Relat Res. 1975;(109 ):9-17
references.pmid: 1132210
references.citation: AJR Am J Roentgenol. 1981 Mar;136(3):553-61
references.pmid: 6781295
references.citation: Skeletal Radiol. 1987;16(2):98-104
references.pmid: 3675731