Pediatrics: Airway Flashcards
What is the most common cause of acute upper airway obstruction in young children?
Croup (peak incidence is 6 months to 3 years)
Neck radiographs showing the steeple sign (loss of the normal lateral convexities of the subglottic trachea)…
Croup (laryngotracheobronchitis)
Seal barking cough…
Croup (laryngotracheobronchitis)
Cause of croup
Viral infection (most often parainfluenza virus)
Neck radiographs showing the thumbprint sign…
Epiglottitis
Note: Look for thickening of the aryepiglottic folds to distinguish from “omega epiglottis” which is just an artifact due to bad technique (oblique images).
Cause of epiglottitis
H. influenza infection (most common)
What age group is epiglottitis most common in?
Average 3.5 years of age (though recent increase in cases in teenagers)
What is the cause of death in epiglottitis?
Asphyxiation due to airway closure from the aryepiglottic folds (not the inflamed epiglottis)
Linear soft tissue filling defect within the airway of an 8 y/o…
Think exudative tracheitis (bacterial tracheitis)
Cause of exudative tracheitis
Staph aureus infection (usually)
Retropharyngeal soft tissue thickening in an 8 month old infant…
Think retropharyngeal cellulitis/abscess
If you can’t tell whether there is real retropharyngeal thickening on a lateral radiograph or just poor technique (oblique, not true lateral), what is the next step?
Repeat lateral neck radiograph with neck extension
Retropharyngeal cellulitis/abscess is most common in what age group?
6-12 months
What is the most common soft tissue mass in the trachea?
Hemangioma (most commonly in the subglottic region)
Radiographs show unilateral loss of the glottic shoulder…
Think subglottic hemangioma
Note: If this were symmetric, think steeple sign in croup (laryngotracheobronchitis).
Subglottic hemangiomas are most common on the ____ side
left
Subglottic hemangiomas are associated with…
- Cutaneous hemangiomas (50%)
- PHACES syndrome (7%)
PHACES syndrome
PHACES:
- Posterior fossa (Dandy Walker)
- Hemangiomas
- Arterial anomalies
- Coarctation of the aorta
- Eye abnormalities
- Subglottic hemangiomas/Sternal cleft/Suproumbilical raphe
During fluoroscopic swallow study of a kid you see a thin tract of contrast extending down the larynx/trachea, but there was no aspiration seen…
Think laryngeal cleft (a rare defect in the posterior wall of the larynx that communicates with the esophagus, allowing contrast to enter the trachea without laryngeal penetration/aspiration)
Laryngeal clefts are associated with…
Other complex GI malformations
If you see contrast appear in the trachea on fluoroscopy without aspiration and are thinking laryngeal cleft, what is the nest step?
Endoscopy for visual confirmation of the posterior laryngeal defect
Lobulated, grape-like mass in the airway of a kid…
Think papilloma (especially if the lungs are full of solid and cavitating nodules)
Airway papillomas are due to…
HPV infection (usually acquired during vaginal birth)
Kid with MULTIPLE regions of air trapping and pulmonary nodules…
Think papillomatosis (HPV infection)
Note: If single region of air trapping, then obstruction from an aspirated foreign body or carcinoid tumor are more likely.
If they show you a frontal neck radiograph of a kid, think…
- Croup (symmetric narrowing)
- Subglottic hemangioma (asymmetric narrowing)
If they show you a lateral neck radiograph of a kid, think…
- Epiglottitis (thumbprint)
- Retropharyngeal abscess (Thickened pre vertebral soft tissues)
- Tonsilitis (Bulky posterior pharyngeal wall)
- Exudative tracheitis (linear tracheal filling defects)
Next step if ED physician suspects epiglottitis…
STAT portable radiograph while waiting for anesthesia consult
Note: Do not bring this kid to the x-ray department, only portable. Keep the kid where they could get an emergency intubation, if needed.
Next step if you see thickening of the retropharyngeal soft tissues on a lateral neck radiograph…
Neck soft tissue CT (to evaluate for retropharyngeal abscess and potential extension to the mediastinum via the danger space)
