Plain radiograph

-imaging modality of choice for- initial evaluation of the

pediatric airway.
-Two views (AP &lateral)
-include airway from the nasal passages & nasopharynx
superiorly upto the carina inferiorly.

**( in young children- increased tissue redundancy- can

simulate pathology – so always obtain the lateral view
during inspiration & with the neck extended

Airway radiographs are helpful in

1. ingested/inhaled foreign bodies (especially if
radiopaque)
2. evaluating sites of midline pharyngeal or tracheal
narrowing due to inflammation or extrinsic
compression.** Most extrinsic processes (such as
peritonsillar abscesses nodal conglomerations)
require further crosssectional imaging
3. infants noisy breathing /Older children with snoring
(in older child single lateral view of the upper airway)

fluoroscopy
In the current era- limited role in
pediatric airway- common circumstance
infant -retropharyngeal space process is
suspected clinically &/or radiographically as
In this setting, the lateral radiograph may
sometimes not be obtained with adequate
extension &/or inspiration - retropharyngeal
tissues appear abnormally thickened when
they are not.
Pulsed fluoroscopic visualization of such an
airway during the respiratory cycle will
demonstrate, in the lateral view, normal
expansion & collapse of the
retropharyngeal soft tissue in this age group
(if there is no
inflammatory change present)

fluoroscopy
may incidentally detect tracheomalacia or
other sites of airway collapse in patients
with obstructive sleep apnea,

Video swallowing studies (a.k.a. modified barium

swallows)
are frequently performed (in conjunction with
speech
pathologists) when aspiration or feeding difficulties
are
suspected.

Another related study is the esophagram. While

this exam is typically performed for dysphagia, it
may have
airway implications if there is a pattern of
esophageal
compression that suggests a vascular ring
Computed Tomography
-In the acute setting, CECT -to detail
drainable abscesses of the retropharynx or
peritonsillar tissues.
-CT angiography - to look for vascular rings
causing compression of the airway (typically
during apulmonaryorotolaryngologywork-up).
-4D cine images of the airway lumen during
the respiratory cycle-.Dynamic change in the
airway caliber

Magnetic Resonance
-typically limited to the evaluation of
recurrent obstructive sleep apnoea after
tonsillectomy- ability to distinguish the
various soft tissue components
contributing to intermittent airway
obstruction- allowing observation of the
supraglottic airway over numerous
respiratory cycles & with the application of
various interventions during the scan.
Ultrasound
Sonography -rarely used -due to the artifacts
associated with air.
-palpable neck masses are well
characterized by ultrasound, their depth of
extension & exact relationship to the airway
a re much better visualized by CT or MR.
Limited uses of airwayUltrasound
-assessment of peritonsillar abscesses (using
an intraoral probe),
-laryngeal motion (by otolaryngologists),
-endotracheal tube position (during point of
care ultrasound by the emergency or ICU
physician).