Utility of Radiographs in the Evaluation of Pediatric Upper Airway Obstruction

Abstract

The evaluation of children with airway obstruction always involves a history and physical examination. The definitive diagnosis is most often made with microlaryngoscopy and bronchoscopy (MLB), and in cases of extrinsic compression, information is gained from magnetic resonance imaging. Although plain radiographs of the airway are often used as a primary diagnostic modality in children with airway obstruction, the accuracy of plain radiographs in predicting specific airway abnormalities has not previously been evaluated. This study was designed to correlate the findings of plain airway radiographs with the diagnosis made at the time of MLB. Medical records from 1991 to 1996 were reviewed to identify patients that had MLB and airway radiographs within 2 days of one another. One hundred forty-four cases were identified and divided into diagnostic categories. Statistical analysis showed a high sensitivity (>86%) for the accuracy of the radiologic diagnoses of exudative tracheitis, airway foreign body, and innominate artery compression. Laryngomalacia and tracheomalacia had a much lower sensitivity (5% and 62%, respectively). We believe that plain radiographic evaluation of the airway provides important information to the diagnostician. However, plain radiographs can be inaccurate and must be considered along with a history, physical examination, and clinical suspicion. Microlaryngoscopy and bronchoscopy remains the ultimate diagnostic test for airway disorders.

Clinical management of upper airway obstruction: epiglottitis and laryngotracheobronchitis

“…O sinal da ponta de lápis nem sempre está presente e pode ocorrer em pacientes sem crupe ou com epiglotite 15,16 . Além disso, nos pacientes com suspeita clínica de epiglotite, a realização do exame radiológico pode vir a retardar o manejo para a obtenção da via aérea.…”

Unique Foreign Body of the Pharynx- Touch Light Spring and Its Plastic Cover

“…If the impacted foreign body is radiolucent, in the present of positive history, symptoms or clinical suspicion, endoscopic examination is suggested [11]. Diagnosis of radio-opaque foreign body ingestion does not pose a major problem.…”

Analysing lateral soft tissue neck radiographs

“…A thorough history and examination remains the cornerstone to managing the patient appropriately. A lateral soft tissue neck radiograph is a cheap, readily available investigation tool that is of clinical value in assessing patients with potential pathology of the upper aerodigestive tract [1,2,[6][7][8][9][10][11][12][13].…”

“…In the emergency department, these radiographs are useful in the assessment of foreign bodies in the hypopharynx and upper cervical oesophagus with some series elucidating sensitivities of over 80% [6][7][8][9][10][11][12][13]. They have no clinical value for foreign bodies in the oral cavity or oropharynx [11].…”

“…1) [17]. Despite their various roles, an integral factor is that lateral neck radiographs must always be correlated with clinical findings [7][8][9].…”