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44 Upper Airway Obstruction in Children

44 upper airway obstruction in children

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44 Upper Airway Obstruction in Children

CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSIS

EISENBERG

DR. Muhammad Bin Zulfiqar PGR-FCPS III SIMS/SHL

• Fig C 44-1 Croup. (A) Smooth, tapered narrowing (arrow) of the subglottic portion of the trachea (gothic arch sign). (B) A normal trachea with broad shouldering in the subglottic region.

• Fig C 44-2 Epiglottitis. Lateral radiograph of the neck demonstrates a wide, rounded configuration of the inflamed epiglottis (arrow).84

• Fig C 44-3 Chicken bone in the glottis.85

• Fig C 44-4 Fibroma of the cervical trachea. Lateral view of the neck shows a sharply defined homogeneous soft-tissue density (arrow) arising from the upper anterior portion of the trachea. This 11-year-old boy had experienced dyspnea and inspiratory stridor for several years.73

• Fig C 44-5 Enlarged tonsils and adenoids. Marked impressions (arrows) on the upper airway.

• Fig C 44-6 Congenital tracheoesophageal fistula. Contrast material injected through a feeding tube demonstrates occlusion of the proximal esophageal pouch (arrows) in (A) frontal and (B) lateral projections. Note the air in the stomach.

• Fig C 44-7 Congenital tracheoesophageal fistula (type IV or H, fistula). Note the sharp downward course of the fistula from the trachea to the esophagus (arrow).

• Fig C 44-8 Tracheomalacia. (A) Inspiratory view demonstrates a normal trachea (arrows). (B) On expiration, the tracheal air column is totally obliterated.85

• Fig C 44-9 Bilateral vocal cord paralysis. (A) Inspiratory view shows the typical midline apposition of the vocal cords (arrows). The hypopharynx (H) is overdistended. T = trachea. (B) On expiration, the vocal cords (arrows) remain in the midline, and the subglottic trachea (T) overdistends.85

• Fig C 44-10 Laryngeal web. (A) Inspiratory lateral view demonstrates an overdistended hypopharynx, an indistinct vocal cord area, and a mild paradoxically narrowed subglottic portion of the trachea (arrows). (B) Inspiratory frontal view demonstrates midline fixation of the cords (arrows) and subglottic narrowing of the entire trachea (T). (C) Expiratory view shows persistent fixation of the vocal cords (arrows) and overdistention of the subglottic trachea (T).85