Pediatric Normal Airway

Etiology: Technical artifact
Imaging:
— Lateral radiographs of the airway must always be taken in inspiration and in extension
— If lateral radiographs of the airway are taken in expiration and in flexion they can mistakenly be interpreted as showing a retropharyngeal abscess
DDX: Retropharyngeal abscess
Complications:
Treatment:
Clinical:

Radiology Cases of Normal Airway

Radiology Cases of Normal Airway Showing Change in Retropharynx During Respiratory Cycle

Airway fluroscopy of a normal pediatric airway — Sequential lateral spot images obtained during fluoroscopy of the airway show the changing appearance of the upper airway from expiration (left most) to inspiration (right most). Note that while in maximum inspiration (right most) the retropharyngeal soft tissues are at their narrowest.

Normal pediatric airway showing change in the retropharynx during inspiration and expiration. — Sequential lateral spot images obtained during fluoroscopy of the airway show the changing appearance of the upper airway during inspiration and expiration. Note that while in maximum inspiration (left) the retropharyngeal soft tissues are at their narrowest when compared to being in maximum expiration (right).

Radiology Cases of Normal Lateral Airway in Inspiration and Expiration Mimicking Retropharyngeal Abscess

Airway images in of false positive retropharyngeal abscess — Lateral radiograph of the neck in expiration and flexion (left) shows apparent thickening of the retropharyngeal soft tissues which disappear upon inspiration (right).

Lateral airway radiograph in expiration mimicking a retropharyngeal abscess — Lateral radiographs of the airway in inspiration (left) and expiration (right) show an increase in the thickness of the retropharyngeal soft tissues in expiration.

Lateral radiograph of the airway in expiration mimicking a pediatric retropharyngeal abscess — Lateral radiographs of the airway in expiration (left) and inspiration (right) show an increase in the thickness of the retropharyngeal soft tissues in expiration.

Radiology Cases of Normal Lateral Airway in Expiration and Flexion Mimicking Retropharyngeal Abscess

Radiograph of normal airway obtained in expiration and flexion mimicking a retropharyngeal abscess — Lateral radiograph of the airway taken in expiration and flexion shows a nearly 90 degree buckling of the trachea and massive thickening of the prevertebral soft tissues. Repeat radiograph obtained in inspiration and extension (not provided) was normal with normal appearing prevertebral soft tissues.

Radiograph of normal airway — Lateral radiograph of the airway taken in expiration and flexion shows nearly 90 degree buckling of the trachea and massive thickening of the prevertebral soft tissues simulating a retropharyngeal abscess. Repeat radiograph obtained in inspiration and extension was normal.

Radiology Cases of Normal AP Airway

AP radiograph of a normal pediatric airway — AP radiograph of a normal airway shows the normal shoulders of the subglottic trachea.

Radiology Cases of Normal AP Airway and AP Airway in Croup

Radiograph of croup — AP radiograph of the airway (right) shows symmetric subglottic narrowing of the trachea leading to loss of the normal shoulders of the subglottic trachea (church steeple sign). AP radiograph of a normal airway for comparison (left) shows the normal shoulders of the subglottic trachea.

Endoscopy Cases of Normal Airway

Endoscopy image of normal airway — Endoscopic image shows the epiglottis in the upper center of the image and aryepiglottic folds lateral to it to be normal in appearance. The airway in the center of the image is of normal caliber.

Endoscopy image of normal airway — Endoscopic image shows the epiglottis in the upper center of the image and aryepiglottic folds lateral to it to be normal in appearance. The airway in the center of the image is of normal caliber.