Pediatric Airway Disorders

Abstract

Airway disorders are very common in children. The etiologies are varied, including congenital, infectious, inflammatory, traumatic, and neoplastic processes. Early recognition is crucial due to potentially life-threatening airway obstruction. Chronically, patients may suffer from recurrent pneumonia or obstructive sleep apnea. Direct visualization with laryngoscopy and bronchoscopy remains the gold standard for diagnosis. However, imaging plays an important role in the evaluation. Neck and chest radiography is first line in the assessment. For definitive anatomical diagnosis and preoperative planning, multidetector CT (MDCT) with multiplanar two-dimensional (2D) and three-dimensional (3D) reconstructions is preferred. Traditionally evaluated with fluoroscopy, real-time airway assessment for such conditions as tracheobronchomalacia and obstructive sleep apnea may now be performed with newer CT methods such as inspiratory–expiratory MDCT, cine MDCT, and four-dimensional MDCT. Although largely limited to evaluating neck masses and vascular patency, ultrasound has recently been successfully used for direct airway imaging. Magnetic resonance imaging (MRI) offers superior contrast resolution without ionizing radiation at the expense of longer scan times and often need for sedation. Cine MRI using fast gradient-echo sequences is an emerging modality allowing for dynamic airway assessment.