DIAGNOSTIC IMAGING

OF LARYNX, BRONCHUS,
AND ESOPHAGUS
JULIE G. CEBRIAN, MD, FPSO-HNS

Diagnostic Imaging of the Larynx,

Trachea and Bronchus
Traditionally, the evaluation of the airway has
included:
1.
2.
3.
4.
5.

Plain film radiography

Barium studies
Fluoroscopy
CT Scan
MRI

Diagnostic Imaging of the Larynx

Plain Film Radiography
Anteroposterior
View
for examining glottic
and subglottic areas

Diagnostic Imaging of the Larynx

Plain Film Radiography
Lateral Radiography
Excellent for identifying the:
1. Tongue
2. Adenoids
3. Tonsils
4. Epiglottis
5. Aryepiglottic folds
6. Pyriform sinuses
7. Laryngeal ventricle
8. Subglottic trachea

Diagnostic Imaging of the Larynx

Plain Film Radiography

Diagnostic Imaging of the Larynx

Plain Film Radiography

Acute Epiglottitis

Retropharyngeal Abscess

Diagnostic Imaging of the Larynx

CT 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 Larynx

CT Scan (Computed Tomography)

Diagnostic Imaging of the Larynx

MRI (Magnetic Resonance Imaging)

Normal Supraglottis

Supraglottic

Diagnostic Imaging of the Larynx

CT Scan

MRI

Energy

Radiation

Magnetism

Tissue signal

Attenuation of x-ray

Under influence of
electromagnetic waves

Density Resolution 100x of plain films

100x of CT

Contrast Medium

Iodine-based

Paramagnetic substance

Risk

Ionizing radiation

Movt of susceptible
metals or devices

Advantages

Fast scanning
Most accessible
Sensitive for
calcification

No radiation
Multiplanar capability
Sensitive for blood
products
Unaffected by dental
amalgam artifact

Diagnostic Imaging
of the Esophagus
1.

Conventional radiography of neck and chest

2.

Full column esophagography

3.

Mucosal relief radiography

4.

Motion recording techniques

5.

Water soluble contrast examination

6.

CT Scan

7.

MRI

Diagnostic Imaging
of the Esophagus

Conventional radiography of neck and ch

1.

capable of demonstrating some advanced

abnormality

minimal role in the diagnosis of esophageal

diseases

Diagnostic Imaging
of the Esophagus
Full column esophagography

2.

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
2.

Full column esophagography

Esophageal Varices

Diagnostic Imaging
of the Esophagus
2.

Full column esophagography

Esophageal Carcinoma

Achalasia

Diagnostic Imaging
of the Esophagus
2.

Full column esophagography

Esophagitis

Leiomyoma

Diagnostic Imaging
of the Esophagus
2.

Full column esophagography

Esophageal
Stricture

Treated Esophageal
Stricture

Diagnostic Imaging
of the Esophagus
Air contrast esophagography

3.

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

4.

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

5.

ideal for evaluation of the cervical esophagus and

detection of esophageal dysmotility and small leaks

Water soluble contrast examination

6.

indicated when perforation of the pharynx or

esophagus is suspected

Diagnostic Imaging
of the Esophagus
CT Scan

7.

imaging procedure of choice for staging

esophageal CA

MRI

8.

less accurate than CT in staging esophageal CA

Radionuclide Imaging

9.

primarily for transit studies

Diagnostic Imaging
of the Esophagus
Foreign 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 Esophagus
Foreign Body Ingestion

MC site of lodgment of FB
- anatomic constrictions:
- cricopharyngeus - MC

70% children

coins, pins, small toys

Diagnostic Imaging
of the Esophagus

Foreign Body Ingestion

3 Stages of Symptoms
I. First Stage
violent paroxysms of coughing or

gagging
II. Second Stage
symptomless interval
III. Third Stage
complications

Diagnostic Imaging
of the Esophagus

Foreign Body Ingestion

First aid during the stage of initial
symptoms:

resisting the urge to do something

What not to do!

slapping the patients back
hanging the child by heels
finger sweeping the throat
attempting blind removal

Diagnostic Imaging
of the Esophagus
Foreign Body Ingestion

Generally speaking:

Esophageal FBs require more urgent

treatment than
those in the tracheobronchial tree.

FBs that have reached the stomach will pass

through
the remainder of the GIT without difficulty.

Diagnostic Imaging
of the Esophagus
Foreign Body

Anteroposterior View

Lateral View

Diagnostic Imaging
of the Esophagus
Foreign Body

Anteroposterior View

Lateral View

Earring

Diagnostic Imaging
of the Esophagus
Foreign Body

Anteroposterior View

Lateral View

Metallic part of a clip

Diagnostic Imaging
of the Esophagus
Foreign Body

Anteroposterior View

Diagnostic Imaging of the Trachea and

Bronchus
Plain Film Radiography

Anteroposterior View

Lateral View

Diagnostic Imaging
of the Bronchus
Foreign Body Aspiration
MC cause of FB aspiration / ingestion in
children

carelesness on the part of the patient or

parent
Children age 4 and below are not able to
adequately
chew nuts, popcorn, and other similar hard
foods

Diagnostic Imaging
of the Bronchus

Foreign Body Aspiration

3 Stages of Symptoms
I. First Stage
violent paroxysms of coughing or

gagging
II. Second Stage
Symptomless interval
III. Third Stage
Complications

Diagnostic Imaging
of the Bronchus
Foreign Body Aspiration
In complete obstruction, the FB must be
disimpacted or

alternate airway established in 4 minutes.

1. Heimlich maneuver
2. Mouth-to-mouth resuscitation
3. Cricothyrotomy
4. Tracheostomy

Diagnostic Imaging
of the Bronchus
Foreign Body Aspiration

FB lodged in larynx
discomfort, hoarseness, cough,
dyspnea

FB lodged in trachea
audible slap, palpable thud

Diagnostic Imaging
of the Bronchus
Foreign Body Aspiration

FB lodged in bronchus
1. peripheral atelectasis

- complete
obstruction
2. asthmatoid-like
wheezing
- non-obstructive
3. check-valve
- partial obstruction

Diagnostic Imaging
of the Bronchus

Foreign 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 sharp
2. uncooked
3. dehydrated
which can absorb fluids and swell within the
lumen.

Diagnostic Imaging
of the Bronchus
Foreign Body

Forceps in the
left main
bronchus

Lateral View

Diagnostic Imaging
of the Bronchus
Foreign Body

End of a ballpoint
pen
in the right main
bronchus

Anteroposterior View

Diagnostic Imaging
of the Bronchus
Foreign Body

Lung with NORMAL

ventilation

Peanut

Right lung is distended

CHECK-VALVE EMPHYSEMA

Diagnostic Imaging
of the Bronchus
Foreign Body

Atelectasis