The Role of Airway Fluoroscopy in the Evaluation of Children With Stridor

Abstract

To determine the sensitivity and specificity of airway fluoroscopy in the diagnosis of pediatric laryngotracheal abnormalities. Design: Retrospective chart review. Setting: Tertiary care children's hospital. Patients: Thirty-nine children, with a mean age of 18 months at the time of evaluation, were evaluated for stridor. Main Outcome Measures: Diagnoses made by airway fluoroscopy and endoscopy. The medical records of patients who had undergone both airway fluoroscopy and airway endoscopy for the evaluation of stridor over a 5-year period were reviewed. The sensitivity, specificity, and positive and negative predictive values of airway fluoroscopy in the diagnosis of laryngomalacia, tracheomalacia, airway stenosis at any level, and airway mass lesions were determined using endoscopic evaluation as the "gold standard." Results: Twenty-three of 39 patients (59%) received a different diagnosis by airway endoscopy than by airway fluoroscopy. The sensitivity of airway fluoroscopy in the diagnosis of laryngomalacia, tracheomalacia, airway stenosis, and an airway mass was 27%, 20%, 69%, and 43%, respectively. The specificity for the same diagnoses was 100%, 94%, 100%, and 100%, respectively. Conclusions: Airway fluoroscopy appears to be reliable in the diagnosis of laryngomalacia, tracheomalacia, airway stenosis, and airway masses because of its high specificity. However, its sensitivity in detecting these common causes of stridor is poor. Negative fluoroscopic study results require further diagnostic evaluation if the clinical indication exists; therefore, the value of fluoroscopy as a screening tool remains uncertain.

Pediatric Stridor

“…28 Airway fluoroscopy can be used in certain cases for identification of dynamic airway lesions such as tracheomalacia. 29 Computed tomography (CT) with three-dimensional reconstruction can assist the practitioner in evaluating airway lesions and planning surgical intervention. 30 and/or magnetic resonance imaging (MRI) are used to evaluate neck or chest masses and aberrant vasculature, such as vascular rings or innominate artery compression.…”

Questioning the legitimacy of rigid bronchoscopy as a tool for establishing the diagnosis of a bronchial foreign body

“…Although DSF as an adjunct to endoscopy in the evaluation of stridor in a child was prospectively found valuable by Rudman et al [21], others emphasized its low sensitivity [22], still acknowledging its high specificity and positive predictive value for findings of airway stenosis. In the instance of a suspected airway FB, DSF is supposed to answer a single question -is there air trapping?…”

Laryngomalacia: factors that influence disease severity and outcomes of management

“…A recent study, however, demonstrates that laryngomalacia and secondary airway lesions in infants can be safely diagnosed by awake FFL with tracheoscopy without the need for anesthesia [3 ]. The role of airway fluoroscopy in the diagnosis of laryngomalacia is an ongoing debate with a reported sensitivity of 27% [6], 35% [7 ] up to 100% [8], and specificity of 67-100% [6,7 ]. The predictive value of airway fluoroscopy in the diagnosis of laryngomalacia is dependent on the expertise and experience of the radiologist.…”