DDX of chronic upper airway obstruction

Approach to chronic upper airway obstruction:

  • Beware of false positive due to expiration / flexion
  • Nasopharynx
    • Tonsillar enlargement – make the tonsils part of your normal scan
    • Choanal atresia – presents with hypoxia with feeding
    • Juvenile nasopharangeal angiofibroma – presents with epistaxis
  • Posterior oropharynx
    • Micrognathia with posterior placement of tongue
    • Macroglossia
    • Inclusion cyst of tongue
    • Thyroglossal duct cyst – midline neck cyst that moves with tongue protrusion + swallowing on US
    • Ectopic thyroid – confirmation is via nuclear medicine scan
  • Larynx / Trachea (intrinsic to airway)
    • Laryngomalacia – can be diagnosed with airway fluoroscopy
    • Congenital cyst of airway
    • Papilloma – suspect with lesions are multiple + associated with cystic chest lesions
    • Granuloma – requires history of longstanding endotracheal intubation
    • Hemangioma – concurrent skin hemangioma makes the diagnosis
    • Chronic airway foreign body – 95% of airway foreign bodies are radiolucent
  • Neck (extrinsic to airway)
    • Lymphatic malformation – transpatial mass that is micro- or macrocystic and not very vascular
    • Hemangioma – solid mass that is hypervascular
    • Lymphoma – lymphadenopathy can surround, shift, compress trachea
    • Esophageal foreign bodies can cause surrounding edema leading to tracheal narrowing