Utility of radiographs in the evaluation of pediatric upper airway obstruction

The evaluation of children with airway obstruction always involves a histor y and physical examination. The definitive diagnosis is most often made wit h microlaryngoscopy and bronchoscopy (MLB), and in cases of extrinsic compr ession, information is gained from magnetic resonance imaging. Although pla in radiographs of the airway are often used as a primary diagnostic modalit y in children with airway obstruction, the accuracy of plain radiographs in predicting specific airway abnormalities has not previously been evaluated . This study was designed to correlate the findings of pi ain airway radiog raphs with the diagnosis made at the time of MLB. Medical records from 1991 to 1996 were reviewed to identify patients that had MLB and airway radiogr aphs within 2 days of one another. One hundred forty-four cases were identi fied and divided into diagnostic categories. Statistical analysis showed a high sensitivity (>86%) for the accuracy of the radiologic diagnoses of exu dative tracheitis, airway foreign body, and innominate artery compression. Laryngomalacia and tracheomalacia had a much lower sensitivity (5% and 62%, respectively). We believe that plain radiographic evaluation of the airway provides important information to the diagnostician. However, plain radiog raphs can be inaccurate and must be considered along with a history, physic al examination, and clinical suspicion. Microlaryngoscopy and bronchoscopy remains the ultimate diagnostic test for airway disorders.