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Outline Relevant Anatomy Cases Epiglottitis Retropharyngeal Abscess Bacterial Tracheitis Croup FB Test Characteristics.

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Presentation on theme: "Outline Relevant Anatomy Cases Epiglottitis Retropharyngeal Abscess Bacterial Tracheitis Croup FB Test Characteristics."— Presentation transcript:

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2 Outline Relevant Anatomy Cases Epiglottitis Retropharyngeal Abscess Bacterial Tracheitis Croup FB Test Characteristics

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5 Case 1Case 1 4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

6 When to order films…When to order films… Sub-acute presentation Diagnosis is unclear Impending airway embarrassment something else

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11 Epiglottitis Enlarged epiglottis Loss of valecular airspace Thickened aryepiglotic folds Distended hypopharynx Straightening of the cervical spine Sensitivity (38-88%) Specificity (78%) Croup and epiglottitis: a radiologic study. AU Stankiewicz JA; Bowes AK SO Laryngoscope 1985 Oct;95(10): Epiglottitis and croup. AU Sobol SE; Zapata S SO Otolaryngol Clin North Am Jun;41(3):551-66, ix. Adult epiglottitis: the Toronto Hospital experience. AU Solomon P; Weisbrod M; Irish JC; Gullane PJ SO J Otolaryngol Dec;27(6):332-6.

12 Case 1Case 1 4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

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15 Retropharyngeal InfectionRetropharyngeal Infection Widened retropharyngeal space C2 – 7mm or C6 – 14mm (kids) C6 – 22mm (adults) Reversal of normal cervical lordosis Foreign body Air-fluid level Gas

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17 False Pre-vertebral SwellingFalse Pre-vertebral Swelling Oblique lateral Neck flexion Crying

18 Case 1Case 1 4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

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21 Case 1Case 1 3 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

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25 Case 1Case 1 4 year old male Inspiratory stridor Unwell for past 24 hours Mom found him in his room with increased work of breathing

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27 Foreign BodyForeign Body Visualization of radiopaque FB Widened pre-vertebral shadow Loss of lordosis Location Esophagus – coronal plane Trachea – sagittal plane (best seen on lateral)

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31 Test CharacteristicsTest Characteristics SensitivitySpecificity Epiglottitis33-88%78% Retropharyngeal abscess80%100% Croup Foreign Body84%

32 Questions? Thank You!

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34 Triple blinded prospective study 100 elective surgery patients Lateral neck x-ray compared with Mallampati Anesthesiologist gold standard (grade III or IV) Results Mallampati sens: 26% spec: 100% Lateral neck film: sens: 100% spec:100%

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41 Adult Epiglottitis Radiographic Criteria Epiglottic height-to-width ratio >0.6 Epiglottic to C4 vertebral body width ratio >0.33 Aryepiglottic fold to C3 vertebral body width ratio >0.35 Prevertebral soft-tissue to C4 vertebral body width ratio >0.25 Hypopharyngeal airway to C4 vertebral body width ratio >1.5

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