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Pediatric radiology 1-100 > Airway > Flashcards

Airway Flashcards

1
Q

How do you broadly classify airway obstruction?

A

upper and lower airway

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2
Q

What is the anatomical landmark to differentiate upper and lower airways?

A

thoracic inlet

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3
Q

What are the symptoms for upper airway obstruction?

A

Stridor

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4
Q

What are the symptoms for lower airways obstruction?

A

Expiratory wheeze

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5
Q

What are the xrays requested for acute respiratory distress?

A

Xray neck AP/ Lat (upper airway)

Xray chest AP/ Lat (lower airway)

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6
Q

Will you take neck AP/ lat in a patient with expiratory wheeze (lowe airway symptoms)?

A

Yes

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7
Q

What are the differential diagnosis for upper airway obstruction?

A

Croup (LTB)
Epiglotitis
exudative tracheitis
retropharyngeal abscess / Cellulitit

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8
Q

What is the age range for croup?

A

6 months to 3 years

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9
Q

What is the age range for Epiglotitis/ Exudative tracheitis/ retropharyngeal abscess?

A

more than 3 years. Upper limit varies for each disease

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10
Q

Clinical presentation of croup?

A

barky cough
intermittent strido
may be associated with lower respiratory tract infection

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11
Q

How is croup treated?

A

inhaled steroid

OP treatment

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12
Q

Xray findings of croup?

A

Steeple sign: narrowing of subglottic trachea extending below the pyriform fossa

Loss of normal shouldering of subglottic trachea

Lateral: narrowing of subglottic trachea

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13
Q

Summarize croup

A

Occurs in less than 3 years age
barking cough, intermittent stridor.
Xray - steeple sign, lateral shows narrowing of subglottic trachea.
epiglottis is normal
treatment is reassurance, inhaled corticosteroids outpatient treatment

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14
Q

How common is epiglottitis?

A

It was fairly common prior to Hib vaccination. Now it is less common

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15
Q

Why should you worry about epiglottits?

A

It is a fatal condition and cause death

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16
Q

clinical presentation of epiglottitis?

A

toxic, fever, dysphagia, stridor and increased respiratory distress while lying down.

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17
Q

Prior to vaccination what was the peak age of presentation?

A

3.5 years, after vaccincation it is 14 years

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18
Q

What additional care should be taken in patients with croup?

A

patient should not be forced to lye down if uncomfortable. all maneuvre should be avoided

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19
Q

xray finding in croup?

A

thumb like appearance of epiglottis in lateral radiograph

thickening of aryepiglottic fold

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20
Q

Where is aryepiglottic fold located?

A

it extends from epiglottis anterosuperiorly to arytenoid cartilage posteroinferiorly

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21
Q

what is the normal appearance of areyepiglottic fold?

A

it is convex inferiorly

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22
Q

What is abnormal in aryepiglottic fold in croup?

A

It has superior convexity

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23
Q

Sometimes the epiglottis appears spuriously enlarged! how do you confirm or defer epiglottitis?

A

No aryepiglottic fold thickening - no epiglottitis.

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24
Q

Summarize epiglottitis

A

Occurs more than age of 3.
prior to vaccine - peak 3 years
post vaccinne - peak at 14 years
fatal condition - can cause death
manuevres and incomcortable position should be avoided
presents with fever, stridor, dysphagia
xray shows thumb sign (thickened epiglottis) with thickening of aryepiglottic fold

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25
Q

How do you differentiate epiglottitis from LTB?

A

LTB will never have thumb sign, will always have subglottic narrowing (steeple sign)
Epiglottitis will always have thumb sign with or without subglottic narrowing

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26
Q

what is Exudative tracheitis?

A

life threatening upper airway obstruction due to purulent bacteral infection of the trachea, commonly staph aureus

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27
Q

What is the age range of Exudative tracheitis?

A

6-10 years

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28
Q

What are the 2 xray presentation of exudative tracheitis?

A
  1. ) intraluminal linear filling defect

2. ) plaque like irregularity of the tracheal wall

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29
Q

Non adherent mucous Vs exudative membrane. How do you differentiae?

A

make the child cough and repeat xray. mucous will move

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30
Q

why is it important to take both AP and lateral in exudative tracheitis?

A

because membranes maybe seen in both, or either one. Sometime you might miss it on lateral but pick it in the AP film or vice versa.

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31
Q

What is the complication of exudative tracheitis?

A

sloughing of membrane and respiratory arrest.

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32
Q

what is the treatment of exudative traceitis?

A

endoscpic removal of membranes with intubation

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33
Q

what is Retropharyngeal cellulitis?

A

It is a pyogenic infection of the retropharyngeal space that is due to a recent upper or lower respiratory tract infection

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34
Q

What is the clinical presentation retropharyngeal cellulitis?

A

fever, stiff neck, dysphagia and stridor

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35
Q

what is the age of presentation retropharyngeal cellulitis?

A

more than half occur between 6-12 months

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36
Q

xray features of retropharyngeal abscess?

A

prevertebral soft tissue thickening

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37
Q

How do you differentiate retropharyngeal abscess from cellulitis?

A

retrophyngeal abscess will have air, cellulitis will not have air.

CT will show low attenuation collection in case of abscess

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38
Q

What is pseudothickening of prevertebral soft tissue?

A

false thickiening due to positioning (flexion). should be repeated in extension to confirm

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39
Q

When do you do a CT?

A

You always do a CT when you see a prevertebral soft tissue thickening

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40
Q

When do you call there is prevertebral soft tissue thickening?

A

when the soft tissue is more than than AP length of the adjacent cervical vertebra

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41
Q

Do you drain a retropharyngeal abscess or cellulitis?

A 
only abscess (most common).
cellulitis is treated conservatively
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42
Q

Summarize retropharyngeal abscess

A

Occurs between 6-12 months
prevertebral soft tissue thickening
patient usually undergoes CT
Abscess will have air

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43
Q

Large aiway obstruction differential diagnosis?

A

Intrisic obstruction
fireign body
tracheomalacia
nedobronchial mass

Extrinisic compression:
Vascular sling
lymphnode enlargement

44
Q

Tracheomalacia

A

traceal wall softening due to abnormal tracheal cartilage rings

45
Q

can tracheomalacia diagnosed with lateral film alone?

A

it cannot be diagnosed with static films

46
Q

How is tracheomalacia diagnosed?

A

dynamic imaging - lateral fluoroscopy or endoscopy

47
Q

What are the most common mass of trachea in children?

A

hemangiomas

48
Q

What is the location of tracheal hemangiomas?

A

subglottic

49
Q

What is the imaging appearance of tracheal hemangioma?

A

asymmetric subglottic narrowing

50
Q

What additional finding would you see in patient with tracheal hemangioma?

A

facial hemangioma

51
Q

What are the differential for endotracheal mass?

A

papilloma/ tracheal granuloma

52
Q

What is the common location for foreign body?

A

brochus

53
Q

what is the clinical presentation?

A

It is usually silent if in the brochus. Tracheal foreign body presents with stridor

54
Q

What is the appearance of xray in a patient with foreign body?

A

It can reduced, normal or increased

55
Q

how do you confirm a foreign body?

A

You take in inspiration and expiration.

The affected lung will remain the same due to air trapping.

56
Q

What do you do if the child is uncooperative ?

A

take bilateral double decubitus

57
Q

what is the differential diagnosis for foreign body?

A

Swyer James syndrome and pulmonary hypoplasia 11111

58
Q

What is the presentation of tracheal foreign body?

A

acute respiratory distress, stridor

xray shows soft tissue density within the trachea

59
Q

Differential diagnosis of extrinisc lower airway obstruction - vascular causes?

A 
Cardio vascular causes?
Vascular sling
enlargment of ascending aorta
enlargement of pulmonary arteries
malposition of descending aorta
enlargement of the left atrium
60
Q

Differential diagnosis of extrinisc lower airway obstruction - vascular causes?

A 
Pulmonary slings
Enlarged ascending aorta (Marfan's)
enlarged pulmonary arteries (due to cong. absence of pulmonary valve)
malposition of descending thoraic aorta
enlargement of left atrium
61
Q

Differential diagnosis of extrinisc lower airway obstruction - mediastinal causes?

A

middle mediastinal mass (bronchogenic cyst)
large anterior mediastinal mass
narrow thoracic inlet

62
Q

What is double aortic arch

A

congenital anomaly due to persistence of bboth right and left fourth aortic arche

63
Q

Presentation of DAA?

A

presents soon after birth.
usually symptomatic
Mostly isolated

64
Q

xray lateral

A

anteriorr indentation of trachea and posterior indentation of esophagus

In AP there is bilateral indentation on either side

65
Q

Which arch in DAA is dominant?

A

the bigger arch

66
Q

Which side is usually dominant in DAA?

A

right side

67
Q

Which arch is superior in DAA?

A

Right side

68
Q

Why is it immportant to which one is dominant?

A

because the treatment is ligation of the non dominant arch. If right side is dominant -left thoracotomy. If left is dominant - right thoracotomy

69
Q

which tracheal level does the DAA compress?

A

mid/ lower trachea

70
Q

What is a pulmonary sling?

A

It is the anomalous origin of lrft pulmonary artery from right pulmonary artery.
It passes between the trachea and esophagus.

71
Q

what is characteristic finding in pulmonary sling?

A

impression in the posterior aspect of trachea

impression over the anterior aspect of esophagus

72
Q

What is the CT finding of pulmonary sling?

A

pancake trachea - due to anterioposterior compression

73
Q

what is the association of pulmonary sling?

A

asymmetric lung inflation
congenital heart disease
complete tracheal ring
anomalous origin of right bronchus

74
Q

what should you suspect if the trachea is narrowed and round superior to the pulmonary sling?

A

complete ring

75
Q

what is right aortic arch with aberrant left SCA

A

it is the same as mentioned in the question. haha

76
Q

Is right aortic arch with aberrant left SCA a complete ring?

A

yes, the right arch indents the trachea anteriorly. Aberrant left SCA causes posterior indentation. The ring is completed by ligamnetum arteriosum

77
Q

Is left aortic arch with aberrant right SCA a ring?

A

no, it is not a ring. It causes posterior indentation of esophagus
It may rarely cause dyspahgia

78
Q

What is the dysphagia called in left aortic arch with aberrant right subclavian artery?

A

dysphagia lusoria

79
Q

What additional investigation you have to do in right aortic arch with aberrant left SCA?

A

CT, as it cannot be reliably distinguished from DAA

80
Q

What are the mechanisms by which a RAA with ALSCA can cause air compromise?

A
  1. Kommerell diverticulum - dilated root of SCA arising from RAA.
  2. Descending aorta may lie in the midline (usually it is on the side) and cause tracheal compression
81
Q

What is the difference between inominate artery compression syndrome Vs Innominate artery compression?

A

asymptomaic patients are called syndrome

82
Q

what are the findings in innominate artery compression syndrome?

A

the innominate artery arises slightly towards the left from the aortic arch
and due to the presence of thymus, the thoracic inlet is crowded. this causes compression
As the child grows and thymus involutes, improves.

83
Q

What are the finding in xray and CT in innominate artery compression syndrome?

A

anterior compression of trachea

84
Q

differential for posterior indentation of esophagus?

A

DAA
RAA with ALSCA
LAA with ARSCA

85
Q

Obstructive sleep apnea (OSA) what are the causes in children?

A

adenoid/ tonsillar enlargement

86
Q

What are the problems with OSA?

A

morbitites, excess sleep, attention deficit, poor performance

87
Q

Lateral radiograph finding of adenoids?

A

> 12 mm soft tissue convex mass in the nasopharynx

88
Q

how is tonsils evaluated?

A

physical exam, though it can be seen in lateral radiographs as soft tissue mass extending from soft palate

89
Q

When is MRI done for OSA?

A

when symptoms dont improve after adenoid/ tonsil removal
multilevel obstruction as in Down’s
severe obesity
prior to major airway surgery

90
Q

What is the technique of MR?

A

MR with T1, T2, GRE (cine) images

91
Q

When do you call recurrent enlarged adenoids tonsils?

A

More than 12 mm anterior posterior diameter
Associated intermittent collapse of hypopharynx
V shaped defect maybe seen.

92
Q

What is the imaging feature of enlarged lingual tonsils?

A

Dumbbell shaped mass immediately posterior to the tongue in MRI

93
Q

Why is it important to diagnose lingual tonsils?

A

It is missed in physical examination

Easily treatable

94
Q

What is glossoptosis?

A

Posterior motion of tongue during sleep

95
Q

What is glossoptosis associated with?

A

Large tongue
Small jaw
Decrease muscular tone

96
Q

What syndromes are associated with glossoptosis?

A

Pierre Robin syndrome
Down syndrome
Neuromuscular disorders

97
Q

What are the imaging findings of glossoptosis in cine MRI?

A

Intermittent falling of tongue posteriorly and abutting posterior pharyngeal wall

98
Q

What are the causes of hypopharyngeal collapse?

A

It can be primary or secondary

99
Q

What is the definition of primary hypopharyngeal collapse?

A

Idiopathic

100
Q

What is secondary hypopharyngeal collapse?

A

Is due to a superior obstruction comma example adenoid tonsils

101
Q

What is the characteristic imaging feature of hypopharyngeal collapse?

A

Cylindrical collapse of the retroglossal Airway.

The anterior posterior left and right Airway all collapse centrally

102
Q

How do you differentiate hypopharyngeal collapse from glossoptosis?

A

Glossoptosis has only anterior posterior motion of tongue whereas hypopharyngeal collapse has Central collapse

103
Q

What are the constellation of findings in chaos?

A

Increase lung volumes, flattened hemidiaphragms, hydrops, polyhydramnios.

104
Q

How is the chaos patient treated?

A

Exit procedure

105
Q

What is exit procedure?

A

The head of Infant is delivered via cesarean, Airway is established with intubation, then the baby is delivered

Pediatric radiology 1-100 (1 decks)

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