Radiology of the Pediatric Respiratory System
William A. Mize M.D.
University of Minnesota Hospital and Clinic
Technique Upper Airway
Radiography
Fluoroscopy
Ultrasound
Computed tomography
MRI
Radiography Upper Airway
AP
Piriform sinuses
Larynx
Subglottic trachea
Lateral
Nasopharynx
Adenoids
Oropharynx
Hypopharynx
Valleculae
Epiglottis/aryepiglottic folds
Larynx
Prevertebral soft tissues
Trachea
Fluoroscopy Upper Airway
Laryngomalacia
Tracheomalacia
Retropharyngeal cellulitis
CrossSectional Imaging Upper Airway
Congenital anomalies
Masses
Infection/abscess
Choanal Atresia
Congenital obstruction of posterior nasopharynx
Soft tissue vs. bony
Respiratory distress if bilateral
CanŐt pass nasogastric tube
Choanal Atresia Imaging
Plain film often normal
Computed tomography
Preimaging decongestants
+/ contrast
Fluoroscopy
Contrast study
Nasal Encephalocele
Hernation of meninges/neural elements thru cribriform plate or open suture
Presents as nasal mass, epistaxis, rhinorrhea
DonŐt biopsy it!
Nasal Encephalocele Imaging
CT
Good for bony defect
MRI
Sagittal + coronal planes useful
Better for differentiating meningocele from encephalocele
Juvenile Nasal Angiofibroma
Adolescent boys
Vascular mass centered in pterygopalatine fossa
Nasal obstruction/epistaxis
Juvenile Nasal Angiofibroma Imaging
Plain film soft tissue mass
CT
MRI
Angiography
Preop embolization
Inflammatory Upper Airway Disease
Croup
Epiglottitis
Bacterial tracheitis
Retropharyngeal cellulitis
Croup
Viral upper airway infection
Parainfluenza, influenza
Presentation: 6 months 3 years
Inspiratory stridor
Not very sick
Croup Imaging
Purpose is to exclude other pathology
Congenital subglottic stenosis
Hemangioma
Airway foreign body
Esophageal foreign body
Subglottic tracheal narrowing
Inspiration hypopharyngeal distention, tracheal collapse
Expiration hypopharyngeal collapse, accentuation of local subglottic narrowing
Epiglottitis
Classic = H. flu infection
Other causes of large epiglottis
Other bacteria
EpsteinBarr virus
Thermal/chemical injury
Angioneurotic edema
Hemophilia
Kaposi sarcoma
Presentation: 36 years
Very toxic
Lifethreatening condition from airway obstruction
If diagnosis suspected, donŐt pursue imaging, pursue ENT doc
Epiglottitis Imaging (If You Have To)
Endotracheal intubation/ tracheostomy equipment + experienced doc to accompany patient
Upright lateral airway film
Large epiglottis
Swollen aryepiglottic folds primary cause of obstruction
Bacterial Tracheitis
Usually Staph. aureus
Older and sicker at presentation than patients with croup
Pseudomembranes
Most patients require endoscopic stripping and endotracheal intubation
Bacterial Tracheitis Imaging
Pseudomembranes on lateral radiograph
Irregularity of tracheal lining
Tracheal thickening on CT
Retropharyngeal Cellulitis
Results from lymphatic spread of uper respiratory infection/cervical adenitis
Broad age range
Retropharyngeal Cellulitis Imaging
Prevertebral soft tissue swelling is difficult to assess in young children
Fluoroscopy helpful to confirm
CT/MRI for anatomic extent
CanŐt usually tell from imaging if drainable (need gasfluid or fluidfluid level)
Upper Airway Masses
Lingual thyroid
Hypopharyngeal cysts
Papillomas
Subglottic hemangioma
Cystic hygroma
