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The child with simultaneous stridor and wheezing
S R Poole1, R D Mauro, L L Fan
1Division of Ambulatory Care, University of Colorado School of Medicine, Children's Hospital of Denver 80218.
Insights
Diagnosing simultaneous stridor and wheezing in children can be challenging. Plain x-rays and imaging like barium swallows are crucial for locating airway obstruction caused by congenital, foreign body, or acquired lesions.
Area of Science:
- Pediatric Pulmonology
- Pediatric Otolaryngology
- Pediatric Radiology
Background:
- Simultaneous stridor and wheezing in children often indicate complex airway issues.
- Distinguishing between extrathoracic and intrathoracic causes is critical for diagnosis and management.
- A single or combined airway lesion can present with these symptoms.
Purpose of the Study:
- To analyze the causes and diagnostic methods for simultaneous stridor and wheezing in pediatric patients.
- To evaluate the effectiveness of various imaging techniques in localizing airway obstructions.
Main Methods:
- Retrospective review of 25 pediatric patients with simultaneous stridor and wheezing.
- Inclusion of cases from a children's hospital emergency department and literature review.
- Analysis of diagnostic modalities including plain radiography, barium swallow, and endoscopy.
Main Results:
- Nineteen patients had single airway lesions (9 extrathoracic, 10 intrathoracic); 6 had combined lesions.
- Common causes included congenital lesions (n=8), foreign bodies (n=9), and acquired lesions (n=2).
- Radiography successfully located obstruction in 18 of 25 patients; barium swallow identified vascular rings.
Conclusions:
- Simultaneous stridor and wheezing necessitate a thorough diagnostic approach.
- Imaging, particularly plain x-rays, plays a vital role in identifying the site of airway obstruction.
- Recommendations for the evaluation of pediatric patients with these symptoms are provided.
Abstract:
We describe 25 patients with simultaneous stridor and wheezing. Twelve patients presented to the emergency department of The Children's Hospital of Denver over a two-year period; we found an additional 13 in a review of the literature. A combination of two disorders produced stridor and wheezing in six patients, with one condition in the extrathoracic airway and one in the intrathoracic airway. The remaining 19 patients had single lesions, nine with obstruction of the extrathoracic airway and 10 with obstruction of the intrathoracic airway. The causes of stridor and wheezing in these 19 patients fell into three general categories: (1) congenital lesion affecting the airway (eight patients); (2) foreign body in the airway or esophagus (nine patients); and (3) acquired lesion affecting the airway (two patients). All eight patients with congenital lesions developed symptoms by four months of age. All nine patients with an airway or esophageal foreign body were between five and 30 months of age. The history may be misleading, and the physical examination often cannot discriminate among the various likely diagnoses. However, the addition of four plain x-ray views (lateral neck, posteroanterior and lateral chest, and forced expiratory chest) located the site of obstruction in 18 of 25 patients. Barium swallow identified the two patients with vascular rings. Four patients underwent endoscopy to determine the site of obstruction. We make recommendations for evaluation of these patients.