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Congenital Stridor Workup

  • Author: Timothy D Murphy, MD; Chief Editor: Michael R Bye, MD  more...
 
Updated: Jan 21, 2015
 

Imaging Studies

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  • Chest radiography may be helpful in diagnosing a vascular ring if a right-sided aortic arch is observed in patients with congenital stridor.
  • Standard neck radiography is rarely helpful unless a large mass is responsible for the obstruction. High-kilovoltage radiography can highlight the tracheal structures better and may provide more information. These radiographs use a higher radiation dose.
  • CT scanning of the neck and chest may be helpful, especially if the radiology facility can perform airway reconstruction imaging. However, the need for cooperation in generating such images limits the use of CT imaging in infants and young children with congenital stridor.
  • Barium esophagraphy can be helpful in diagnosing vascular rings if an indentation in the esophagus is present. The pattern of indentation may also be helpful in indicating what type of vascular anomaly may be present. However, the lesion of anomalous innominate artery does not yield abnormal findings on esophagraphy.
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Other Tests

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  • A multichannel sleep study that measures airflow, chest wall excursion, oxygen saturation, and heart rate can provide useful information about the severity of obstruction.
  • An ABG study can reveal the presence of carbon dioxide retention or chronic hypoxemia.
  • In cases of suspected gastroesophageal reflux (GER), 24-hour mid esophageal pH monitoring may be helpful in establishing the diagnosis.
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Procedures

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  • Fiberoptic laryngoscopy and bronchoscopy, valuable diagnostic tools for the evaluation of congenital stridor, offer several important advantages over radiographic imaging, including the following:
    • Lesions can be directly visualized. Evidence of inflammation or bleeding can be observed. Characteristics of the lesion, such as vascularity, can be determined.
    • Biopsies and bronchoalveolar lavage samples can be taken if necessary.
    • The examination is conducted while the patient is actively breathing, allowing assessment of dynamic events.
  • Fiberoptic direct laryngoscopy can be performed in the office. However, in the pediatric population this procedure can be performed most safely while the patient is sedated. Bronchoscopy in a child requires intravenous conscious sedation or general anesthesia.
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Contributor Information and Disclosures
Author

Timothy D Murphy, MD Consulting and Attending Staff, Pediatric Pulmonary and Sleep Medicine, Mary Bridge Children's Hospital

Timothy D Murphy, MD is a member of the following medical societies: American Thoracic Society, American Academy of Sleep Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Clement L Ren, MD Chief, Division of Pediatric Pulmonology, Department of Pediatrics, Associate Professor, Golisano Children's Hospital at Strong, University of Rochester, New York

Clement L Ren, MD is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Charles Callahan, DO Professor, Chief, Department of Pediatrics and Pediatric Pulmonology, Tripler Army Medical Center

Charles Callahan, DO is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American College of Osteopathic Pediatricians, American Thoracic Society, Association of Military Surgeons of the US, Christian Medical and Dental Associations

Disclosure: Nothing to disclose.

Chief Editor

Michael R Bye, MD Professor of Clinical Pediatrics, State University of New York at Buffalo School of Medicine; Attending Physician, Pediatric Pulmonary Division, Women's and Children's Hospital of Buffalo

Michael R Bye, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society

Disclosure: Nothing to disclose.

Additional Contributors

Thomas Scanlin, MD Chief, Division of Pulmonary Medicine and Cystic Fibrosis Center, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School

Thomas Scanlin, MD is a member of the following medical societies: American Association for the Advancement of Science, Society for Pediatric Research, American Society for Biochemistry and Molecular Biology, American Thoracic Society, Society for Pediatric Research

Disclosure: Nothing to disclose.

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Breath sound assessment. Video courtesy of Therese Canares, MD, and Jonathan Valente, MD, Rhode Island Hospital, Brown University.
 
 
 
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