Congenital Stridor Workup

Updated: Mar 05, 2018
  • Author: Timothy D Murphy, MD; Chief Editor: Denise Serebrisky, MD  more...
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Workup

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.

  • Laryngeal ultrasound (LUS) can demonstrate arytenoid adduction during inspiration to provisionally diagnose laryngomalacia. [9]

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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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