CLINICAL IMAGAGINGAN ATLAS OF DIFFERENTIAL DAIGNOSISEISENBERG

1. 44Upper Airway Obstruction in
Children

2. CLINICAL IMAGAGING
AN ATLAS OF DIFFERENTIAL DAIGNOSIS
EISENBERG
DR. Muhammad Bin Zulfiqar
PGR-FCPS III SIMS/SHL

3. • 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.

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

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

6. • 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

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

8. • 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.

9. • 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).

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

11. • 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

12. • 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