Difference between revisions of "Subglottic stenosis"

(Differential Diagnosis)
(Differential Diagnosis)
Line 21: Line 21:
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
*Vocal cord paralysis
 
*Subglottic hemangioma
 
*Tumor (metastatic, benign airway tumors, primary endoluminal malignancies)
 
*Vascular ring
 
*Smoke injury
 
*Chemical burn
 
*Foreign body
 
*Tracheal stenosis (not at the subglottic region)
 
*Tracheomalacia<ref> Ernst A, Feller-Kopman D, Becker HD, Mehta AC. Central airway obstruction. Am J Respir Crit Care Med 2004</ref>
 
 
 
{{Stridor DDx}}
 
{{Stridor DDx}}
  

Revision as of 11:51, 10 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 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