Physical Exam Key Points

1. Characteristics of stridor. May help localize site of airway narrowing. Stridor that is primarily inspiratory is generally caused by extrathoracic lesions; stridor that is primarily expiratory, by intrathoracic lesions. Biphasic stridor may be caused by tracheal lesions, or severe airway narrowing in any location. Stridor may be primarily high or low pitched.

2. Wet sounds. Anatomic or neurologic inability to clear secretions.

3. Hoarseness. Lesion includes, but is not necessarily limited to, true vocal folds.

4. Pectus deformity. Airway obstruction is long-standing or severe.

5. Unilateral decreased breath sounds. Suggestive of decreased airflow to that side.

B. Laboratory Data. Normal pulse-oximetry reading does not rule out significant airway lesion.

C. Radiographic and Other Studies

1. Lateral neck x-ray. May show subglottic narrowing from subglottic stenosis, croup, or other lesions.

2. Chest x-ray (lateral and AP or PA). May demonstrate the following.

a. Radiodense foreign body. More often, x-ray does not demonstrate foreign body but may show its sequelae. If there is partial airway obstruction, x-ray may demonstrate air trapping; if complete obstruction, postobstructive atelectasis.

b. Abnormal tracheal anatomy. From vascular ring or other extrinsic tracheal compression.

c. "Steeple sign." Narrowing of subglottic airway from croup.

3. Inspiratory and expiratory x-rays or decubitus x-rays. May demonstrate air trapping that may not be evident on erect x-rays.

4. Airway fluoroscopy. Useful if radiographic findings are subtle or patient is uncooperative.

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