AM Report

Danielle Smith MD MPH

April 15, 2011
Diagnosis of Stridor in Children
 Stridor
 Latin word "stridulus,“=creaking, whistling or
grating
 confused for wheezing
 Inspiratory: above glottis
 Expiratory: below glottis
 Biphasic: glottic/subglottic
Causes of Stridor in Children
According to Site of Obstruction
http://www.aafp.org/afp/991115ap/2289.html
 Nose and Pharynx
 Choanal atresia
 Lingual thyroid or thyroglossal cyst
 Macroglossia
 Micrognathia
 Hypertrophic tonsils/adenoids
 Retropharyngeal or peritonsillar abscess
 http://www.aafp.org/afp/991115ap/2289.html
 Larynx
 Laryngomalacia  Intubation
 Laryngeal web, cyst, or  Foreign body
laryngocele  Cystic hygroma
 Laryngotracheobronchitis  Subglottic hemangioma
 Acute spasmodic  Laryngeal papilloma
laryngitis (spasmodic  Angioneurotic edema
croup)
 Laryngospasm
 Epiglottitis (hypocalcemic tetany)
 Vocal cord paralysis  Psychogenic stridor
 Laryngotracheal stenosis

 http://www.aafp.org/afp/991115ap/2289.html
 Trachea
 Tracheomalacia
 Bacterial Tracheitis
 External compression
 http://www.aafp.org/afp/991115ap/2289.html
 Rings and Slings

 Congenital vascular anomalies

 Encircle and lead to compression of the esophagus
and trachea
 Complete and Incomplete
 Respiratory
 Stridor, wheezing, noisy breathing, cough,
recurrent respiratory infections, ALTE
 Feeding
 Gagging or choking with eating, FTT, emesis
 4th week of
embryogenesis, aortic
arch develops from six
symmetrical paired aortic
arch vessels and the
paired dorsal aortae
 Branchial arteries come
off of truncus arteriosus
 Inapproriate regression or
persistence cause the
different vascular ring
anomalies 1. Internal carotid artery
2. External carotid artery
3. Common carotid artery
4. Right subclavian artery
5. Arch of aorta
6. Brachiocephalic artery
7. Ductus arteriosus
8. 7th intersegmental artery
9. Pulmonary artery
10. Carotid duct
11. Obliterated right dorsal aorta
www.chronolab.com/embryo/images/S2_4_08.jpg
 Double aortic arch
 http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004569/

 Right Aortic Arch with Retroesophageal

Left Ligamentum Arteriosum
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1524719/

 Anomalous innominate artery

 http://www.ncbi.nlm.nih.gov/pubmed/11426802

 Aberrant Right Subclavian Artery

 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764953/?tool=pubmed

 Vascular Sling
 http://radiology.rsna.org/content/216/3/624.full.pdf
 Diagnosis and Treatment
 CXR: tracheal narrowing/displacement,
arch location, atelectasis
 Esophagram
 Bronchoscopy
 Echo
 CT/MRI
 Surgery if airway compromise