Neck Airway (Soft Tissue) X-ray

What it is

Most neck x-rays are ordered to look at the seven bones of the cervical spine. This one is not. The technique is set differently so that the softer structures — the throat, the voice box, the windpipe and the tissue behind them — are what comes through, with the air inside the airway acting as its own natural contrast. That column of air is normally an even, smooth channel. Swelling in the wall, a mass behind it, or something swallowed and stuck will change its shape, and that change is what the radiologist is looking for. The usual study is a side view with the neck extended, often with a front view as well.

Why it is done

• To look at a narrowed or irregular airway in a child with a barking cough or noisy breathing
• To look for swelling in the tissues behind the throat, which can push the airway forward
• To find an object that has been swallowed or inhaled, when it is dense enough to show on an x-ray
• To check the soft tissues of the neck after an injury, alongside or instead of pictures of the bones

What to expect

Nothing needs to be done in advance. The patient stands or sits in front of the imaging plate, or lies on the table, with the chin lifted and the neck gently extended so the airway is not folded on itself. The exposure is timed, ideally on a breath in, to open the air column as much as possible. It takes seconds and does not hurt. A frightened or struggling child is usually the hardest part; a parent may be asked to help with positioning. A child who is working hard to breathe may be kept upright and monitored rather than laid flat, and in some cases imaging is skipped entirely in favor of treating first.

Questions worth asking

• Is this being billed as a soft tissue neck study or as a cervical spine series? They are different exams at different prices, and both are sometimes ordered together.
• Was the image taken with a portable machine at the bedside? Portable films are often billed at a higher rate than the same view in the radiology department.
• If this is an emergency department visit, is the x-ray separate from the facility's visit-level charge, or already counted inside it?
• Will the film be re-read the next morning by a different radiologist, and does that second reading generate its own charge?