DIAGNOSTIC IMAGING OF LARYNX, BRONCHUS, AND ESOPHAGUSJULIE G. CEBRIAN, MD, FPSO-HNS

Diagnostic Imaging of the Larynx, Trachea and BronchusTraditionally, the evaluation of the airway has included:Plain film radiographyBarium studiesFluoroscopyCT ScanMRI

Diagnostic Imaging of the Larynx Plain Film RadiographyAnteroposterior Viewfor examining glottic and subglottic areas

Diagnostic Imaging of the LarynxPlain Film RadiographyLateral RadiographyExcellent for identifying the:TongueAdenoidsTonsilsEpiglottisAryepiglottic foldsPyriform sinusesLaryngeal ventricleSubglottic trachea

Diagnostic Imaging of the LarynxPlain Film Radiography

Diagnostic Imaging of the LarynxPlain Film RadiographyAcute EpiglottitisRetropharyngeal Abscess

Diagnostic Imaging of the LarynxCT Scan and MRI excellent non-invasive methods capable of 3D anatomic display useful in assessing submucosal extension and cartilaginous destruction neoplasm on CT : area of increased soft tissue density the hallmark of an abnormal larynx on MRI is asymmetry

Diagnostic Imaging of the LarynxCT Scan (Computed Tomography)

Diagnostic Imaging of the LarynxMRI (Magnetic Resonance Imaging)Supraglottic CarcinomaNormal Supraglottis

Diagnostic Imaging of the Larynx

CT ScanMRIEnergyRadiationMagnetismTissue signalAttenuation of x-rayUnder influence of electromagnetic wavesDensity Resolution100x of plain films100x of CTContrast MediumIodine-basedParamagnetic substanceRiskIonizing radiationMovt of susceptible metals or devicesAdvantagesFast scanningMost accessibleSensitive for calcificationNo radiationMultiplanar capabilitySensitive for blood productsUnaffected by dental amalgam artifact

Diagnostic Imaging of the Esophagus Conventional radiography of neck and chest Full column esophagography Mucosal relief radiography Motion recording techniques Water soluble contrast examination CT Scan MRI

Diagnostic Imaging of the Esophagus Conventional radiography of neck and chest capable of demonstrating some advanced abnormality minimal role in the diagnosis of esophageal diseases

Diagnostic Imaging of the Esophagus Full column esophagography a single contrast technique performed with the patient in horizontal position disease processes that alter the contour of the esophagus are well delineated main advantage is the speed with which the examination can be performed

Diagnostic Imaging of the Esophagus Full column esophagographyEsophageal Varices

Diagnostic Imaging of the Esophagus Full column esophagographyEsophageal CarcinomaAchalasia

Diagnostic Imaging of the Esophagus Full column esophagographyEsophagitisLeiomyoma

Diagnostic Imaging of the Esophagus Full column esophagographyEsophageal StrictureTreated Esophageal Stricture

Diagnostic Imaging of the Esophagus Air contrast esophagography the strength of this technique is its ability to demonstrate small esophageal tumors and subtle mucosal irregularities associated with esophagitis

Diagnostic Imaging of the Esophagus Mucosal relief esophagography indicated primarily for suspected esophageal varices lesions requiring distension for demonstration may be invisible with this technique

Diagnostic Imaging of the Esophagus Motion recording techniques ideal for evaluation of the cervical esophagus and detection of esophageal dysmotility and small leaks Water soluble contrast examination indicated when perforation of the pharynx or esophagus is suspected

Diagnostic Imaging of the Esophagus CT Scan imaging procedure of choice for staging esophageal CA MRI less accurate than CT in staging esophageal CA Radionuclide Imagingprimarily for transit studies

Diagnostic Imaging of the EsophagusForeign Body Ingestion History and physical examination Bring a duplicate of the foreign body Nothing per orem prior to endoscopic removal of FB

Diagnostic Imaging of the EsophagusForeign Body Ingestion MC site of lodgment of FB - anatomic constrictions:- cricopharyngeus - MC 70% children coins, pins, small toys

Diagnostic Imaging of the EsophagusForeign Body Ingestion 3 Stages of SymptomsI. First Stage violent paroxysms of coughing or gaggingII. Second Stage symptomless intervalIII. Third Stage complications

Diagnostic Imaging of the EsophagusForeign Body Ingestion First aid during the stage of initial symptoms: resisting the urge to do something What not to do!slapping the patients backhanging the child by heelsfinger sweeping the throat attempting blind removal

Diagnostic Imaging of the EsophagusForeign Body Ingestion Generally speaking:Esophageal FBs require more urgent treatment thanthose in the tracheobronchial tree. FBs that have reached the stomach will pass through the remainder of the GIT without difficulty.

Diagnostic Imaging of the EsophagusForeign Body Anteroposterior ViewLateral View

Diagnostic Imaging of the EsophagusForeign Body Anteroposterior ViewLateral ViewEarring

Diagnostic Imaging of the EsophagusForeign Body Anteroposterior ViewLateral ViewMetallic part of a clip

Diagnostic Imaging of the EsophagusForeign Body Anteroposterior View

Diagnostic Imaging of the Trachea and BronchusPlain Film RadiographyLateral ViewAnteroposterior View

Diagnostic Imaging of the BronchusForeign Body Aspiration MC cause of FB aspiration / ingestion in childrencarelesness on the part of the patient or parent Children age 4 and below are not able to adequatelychew nuts, popcorn, and other similar hard foods

Diagnostic Imaging of the BronchusForeign Body Aspiration 3 Stages of SymptomsI. First Stageviolent paroxysms of coughing or gaggingII. Second StageSymptomless intervalIII. Third StageComplications

Diagnostic Imaging of the BronchusForeign Body Aspiration In complete obstruction, the FB must be disimpacted or alternate airway established in 4 minutes.1. Heimlich maneuver2. Mouth-to-mouth resuscitation3. Cricothyrotomy4. Tracheostomy

Diagnostic Imaging of the BronchusForeign Body Aspiration FB lodged in larynxdiscomfort, hoarseness, cough, dyspnea FB lodged in tracheaaudible slap, palpable thud

Diagnostic Imaging of the BronchusForeign Body Aspiration FB lodged in bronchus1. peripheral atelectasis - complete obstruction2. asthmatoid-like wheezing - non-obstructive3. check-valve - partial obstruction

Diagnostic Imaging of the BronchusForeign Body Aspiration Generally speaking:A foreign body lodged in the tracheobronchial tree, not totally occluding the airway, is not as great an emergency as one that is lodged in the esophagus unless,1. it is sharp2. uncooked3. dehydratedwhich can absorb fluids and swell within the lumen.

Diagnostic Imaging of the BronchusForeign Body Lateral ViewForceps in the left main bronchus

Diagnostic Imaging of the BronchusForeign Body Anteroposterior ViewEnd of a ballpoint penin the right main bronchus

Diagnostic Imaging of the BronchusForeign Body Lung with NORMAL ventilationRight lung is distendedCHECK-VALVE EMPHYSEMAPeanut

Diagnostic Imaging of the BronchusForeign Body Atelectasis