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The value of radiological investigations in pre-endoscopic assessment of children with stridor

Published online by Cambridge University Press:  29 June 2007

P. M. J. Tostevin ,
R. de Bruyn ,
A. Hosni  and
J. N. G. Evans
P. M. J. Tostevin*
Affiliation:
Departments of Otolaryngology, Great Ormond Street Hospital for Sick Children NHS Trust, London.
R. de Bruyn
Affiliation:
Departments of Radiology, Great Ormond Street Hospital for Sick Children NHS Trust, London.
A. Hosni
Affiliation:
Departments of Otolaryngology, Great Ormond Street Hospital for Sick Children NHS Trust, London.
J. N. G. Evans
Affiliation:
Departments of Otolaryngology, Great Ormond Street Hospital for Sick Children NHS Trust, London.
*
Dr P. M. J. Tostevin, Flat 1, Beufort House, 30 Winders Road, Battersea, London SW11 3HB.
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Abstract

The differential diagnosis of stridor in an infant depends on a careful history and examination, followed by radiological and endoscopic investigations. Currently a chest, lateral neck and antero-posterior, high kilovolt (Cincinnatti) view radiographs in association with a diagnostic barium swallow are performed prior to the definitive diagnostic procedure of microlaryngobronchoscopy.

Our impression was that some of the routinely ordered radiological investigations were of limited value in the differential diagnosis. We undertook a retrospective audit study to determine the value of radiological investigations in the pre-endoscopic assessment of infants with stridor. The radiological and endoscopic information of 100 infants presenting over the three-year period 1991–1993 at Great Ormond Street Hospital, London (a tertiary referral centre) was collected.

It was found that only five out of 65 barium swallow investigations performed had consistent positive findings at diagnostic microlaryngobronchoscopy. The lateral neck and Cincinnatti views identified many of the more gross pathologies of the larynx and trachea e.g. the space occupying lesions, which occur infrequently. The more common diseases e.g. laryngomalacia or subglottic stenosis are rarely identified radiologically.

Our results confirmed that radiology had a limited screening role and that in a child presenting with stridor the initial radiological assessment should be a chest radiograph with further imaging and a barium swallow only if an abnormality is found at microlaryngobronchoscopy.

Keywords

LaryngoscopyBronchoscopyRadiologyRespiratory soundsChild
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 109 , Issue 9 , September 1995 , pp. 844 - 848
Copyright
Copyright © JLO (1984) Limited 1995

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