Difference between revisions of "Subglottic stenosis"

(Differential Diagnosis)
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*Past mechanical trauma to the airway (intubation or surgery)
 
*Past mechanical trauma to the airway (intubation or surgery)
 
*Autoimmune disorders  
 
*Autoimmune disorders  
*Wegener granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis <ref>Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.</ref>
+
*[[Wegener's granulomatosis]]/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis <ref>Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.</ref>
*Rheumatoid Arthritis
+
*[[Rheumatoid arthritis]]
*Sarcoidosis
+
*[[Sarcoidosis]]
  
 
==Clinical Features==
 
==Clinical Features==
*Tachypnea/ Dyspnea/ Hypoxia
+
*Tachypnea/ [[Dyspnea]]/ [[Hypoxia]]
 
*Inspiratory [[stridor]]
 
*Inspiratory [[stridor]]
 
*Hoarseness/ Dysphonia
 
*Hoarseness/ Dysphonia
Line 30: Line 30:
 
*ENT referral or immediate securing of airway dependent upon respiratory distress
 
*ENT referral or immediate securing of airway dependent upon respiratory distress
 
*Humidified oxygen
 
*Humidified oxygen
*Proton pump inhibitor
+
*[[Proton pump inhibitor]]
*Systemic steroids
+
*Systemic [[steroids]]
 
*Treat underlying disorder if caused by autoimmune disorder
 
*Treat underlying disorder if caused by autoimmune disorder
  

Revision as of 21:14, 11 August 2017

Background

  • A narrowing of the trachea directly inferior to the vocal cords

Causes

  • Idiopathic (more likely to affect females)
  • Congenital abnormality in newborns
  • Past mechanical trauma to the airway (intubation or surgery)
  • Autoimmune disorders
  • Wegener's granulomatosis/ GPA - Approximately 36% of patients with GPA develop subglottic stenosis [1]
  • Rheumatoid arthritis
  • Sarcoidosis

Clinical Features

  • Tachypnea/ Dyspnea/ Hypoxia
  • Inspiratory stridor
  • Hoarseness/ Dysphonia
  • Respiratory accessory muscle usage
  • Cough
  • "Tightness" in the neck
  • Patients with history of greater than 1 week of intubation

Differential Diagnosis

Stridor

Trauma

Infectious Disorders

Abscesses

Neoplastic Disorders

  • Neoplasms/tumors

Allergic and Auto-Immune Disorders

  • Spasmodic/tracheobronchitis
  • Angioedema/Angioneurotic edema

Metabolic, Storage Disorders

  • Cerebral Gaucher's of infants (acute)
  • Tracheobronchial amyloidosis

Biochemical Disorders

Congenital, Developmental Disorders

Psychiatric Disorders

  • Somatization disorder

Anatomical or Mechanical

Vegetative, Autonomic, Endocrine Disorders

Poisoning

Chronic Pediatric Conditions

Evaluation

  • Direct visualization via scope Subglottic stenosis2.jpg
  • CT Neck

Management

  • ENT referral or immediate securing of airway dependent upon respiratory distress
  • Humidified oxygen
  • Proton pump inhibitor
  • Systemic steroids
  • Treat underlying disorder if caused by autoimmune disorder

Definitive Management:

  • Dilation
  • Crichotracheal resection
  • Tracheotomy

Disposition

  • Admit

See Also

External Links

References

  1. Taylor SC, Clayburgh DR, Rosenbaum JT, Schindler JS. Progression and management of Wegener's granulomatosis in the head and neck. Laryngoscope 2012; 122:1695.
  2. Vocal Cord Dysfunction on Internet Book of Critical Care https://emcrit.org/ibcc/vcd/
  3. Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004