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CORE--Peds > Pediatric Airway > Flashcards

Pediatric Airway Flashcards

1
Q

Causes of upper airway obstruction above trachea

A

choanal atresia, rhabdomyosarcoma, infectious (peritonsillar abscess)

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2
Q

Congenital occlusion of posterior nasal aperture(s)

A

choanal atresia; right side > left; bilateral cases have other anomalies; no communication between nasal cavity and nasopharynx

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3
Q

Types of choanal atresia

A

osseous, membranous, mixed; most are mixed (70%)

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4
Q

Choanal atresia findings

A

thickening of vomer, bowing of posterior maxilla/lateral nasal wall, air fluid level in nasal cavity; make sure to evaluate for associated head and neck anomalies (CHARGE)

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5
Q

Ddx for choanal atresia

A

chonal stenosis (more common than atresia), pyriform aperture stenosis, nasolacrimal duct mucosele

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6
Q

Chonal atresia presentation

A

respiratory distress in newborn if bilateral; chronic purulent unilateral rhinorrhea in older child

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7
Q

Associations with bilateral choanal atresia

A

CHARGE syndrome: coloboma (gap in iris/retina), heart defects, atresia of choanae, retardation of development, GU anomalies, and ear anomalies

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8
Q

Benign hamartomatous vascular lesion in adolescent males in the nasal cavity

A

JNA, juvenile nasopharyngeal angiofibroma

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9
Q

Where does JNA originate?

A

posterior wall of nasal cavity off midline at margin of sphenopalatine foramen –> PPF

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10
Q

Ddx for JNA

A

nasal rhabdomyosarcoma, nasopharyngeal carcinoma, antrochoanal polyp, esthesioneuroblastoma

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11
Q

CT imaging findings of JNA

A

heterogenous vs diffuse, avid enhancement; bone remodeling and destruction (posterior wall of maxillary sinus is bowed anteriorly),

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12
Q

MR findings of JNA

A

flow voids, intense enhancement, diffuse/heterogenous

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13
Q

Angio findings of JNA

A

tumor blush during preop embolization; usually the internal maxillary branch of ECA

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14
Q

JNA presentation

A

unilateral nasal obstruction with epistaxis

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15
Q

What is the antral sign?

A

anterior bowing of the posterior wall of maxillary antrum; nonspecific sign from a slowly growing mass seen in JNA; erosion of pterygoid lamina may be pathognomic for JNA

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16
Q

Most common childhood soft tissue sarcoma

A

rhabdomyosarcoma

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17
Q

Ddx rhabdomyosarcoma

A

JNA, LCH, plexiform neurofibroma, infantile hemangioma, nasopharyngeal carcinoma, lymphoma, leukemia

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18
Q

Pathology of rhabdomyosarcoma, tissue of origin

A

primitive mesenchymal cells (rhabdomyoblasts) commited to muscle differentiation

19
Q

Presentation for rhabdomyosarcoma

A

most under 12 years old; 40% in head and neck (orbit; best prognosis, parameningeal site); increase with p53 tumor suppressor gene mutation and in Noonan syndrome or secondary to radiation therapy

20
Q

Rhabdomyosarcoma CT findings

A

invasive soft tissue mass with variable enhancement, osseous erosion common

Best to evaluate for osseous erosion

21
Q

Rhabdomyosarcoma MR findings

A

T1 isointense, T2 hyperintense to muscle; variable enhancement, intracranial

Best for evaluating intracranila and perineural spread; distinguish between sinonasal tumor and inflammatory disease

22
Q

Pts who get epiglottitis

A

kids prior to H influenza immunization, immunocompromised (HIV, transplant)

23
Q

Imaging findings epiglottitis

A

thickening of epilottis on lateral view (thumprint sign); thickening of aryepiglottic folds

24
Q

Insipratory stridor and barking cough

A

Laryngotracheobronchitis (croup) ; exudative tracheitis can also present similarly

25
Q

Steeple sign

A

Croup; shouldering of subglottic trachea, ballooning of hypopharynx

26
Q

Aspirated foreign body, views

A

AP chest, decubitus views on obstructed side for persistent expansion/air trapping

27
Q

Ddx prevertebral soft tissue swelling

A

retropharyngeal abscess/cellulitis, lymphoma, foregut duplication cyst, pseudothickening from neck flexion,

28
Q

Exudative bacterial tracheitis presentation

A

fever, stridor, resiratory distress; older kids (S aureus) vs H influenza for epiglottitis

29
Q

Imaging exudative tracheitis

A

filling defects/membranes in the subglottic and cervical trachea

30
Q

Most common subglottic tracheal mass

A

subglottic hemangioma

31
Q

Imaging findings subglottic hemangioma

A

asymmetric narrowing of subglottic trachea on frontal view

32
Q

Laryngeal papillomatosis

A

HPV infection with multiple laryngeal nodules and thick/nodular vocal cords; increased risk for laryngeal SCC; can also cause multiple cavitary nodules

33
Q

Tracheobronchomalacia

A

airway collapse from weak cartilage (congenital, intubation, infection, inflammation)

34
Q

Vascular ring vs sling

A

ring: complete encircling of trachea and esophagus; sling: anomalous course of left pulmonary artery that traps trachea on 3 sides

35
Q

Vascular anomaly that causes stridor

A

pulmonary artery sling with a normal left aortic arch or right sided aortic arch with aberrant L subclavian, double aortic arch

36
Q

Most common vascular ring and symptoms

A

Double aortic arch; arches encircle both trachea and esophagus; cause stridor

37
Q

4 artery sign

A

Double aortic arch

38
Q

Second most common vascular ring

A

Right arch with aberrant left subclavan artery; arch indents trachea, left subclavian wraps around esophagus; ring completed by ligamentum arteriosum

39
Q

Ddx lateral esophagram with posterior indentation

A

double aortic arch, aberrant left subclavian with R arch

40
Q

Pulmonary sling

A

Anomalous L pulmonary artery from the right pulmoary artery; courses between trachea/esophagus; may also capture bronchus intermedius

41
Q

Only vascular cause of strider with L arch

A

pulmonary artery sling

42
Q

Associations with pulmonary artery sling

A

tracheal anomalies: tracheomalacia, bronchus suis or pig bronchus (RUL bronchus from trachea)

43
Q

Dysphagia lursoria association

A

L aortic arch with aberrant right subclavian artery; not ring/sling. Not associated with stridor , just dysphagia; posterior indentation of esophagus

44
Q

Innominate artery syndrome

A

large thymus pushes innominate artery against anterior trachea

CORE--Peds (7 decks)

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