The soft tissue anterior to the vertebral bodies may become distorted due to its relative laxity and due to distress.
Physiological rather than pathological soft tissue enlargement should be eliminated by taking the neck out of flexion. Concavity of the soft tissue above and below the arch of C1 suggests a physiological rather than a pathological cause, but in all cases, there should remain a high suspicion of injury.
Image: Anterior soft tissue swelling in a 1-year-old.
Click on the x-ray to enlarge.