Infant Stridor Cheatsheet
Key Concept: Biphasic stridor + external tracheal compression on imaging = vascular ring. Laryngomalacia = inspiratory only, improves prone, resolves by 18 months. Subglottic hemangioma = biphasic, appears weeks after birth, beard distribution. Tracheomalacia = expiratory > inspiratory, associated with EA/TEF repair.
| Diagnosis |
Key Features |
| Laryngomalacia |
- Most common cause of stridor in infants
- Inspiratory stridor only
- Caused by floppy supraglottic structures (epiglottis/arytenoids)
- Worsens supine; improves prone or with neck extension
- Improves with age; resolves by 12-18 months
- Diagnosed by flexible laryngoscopy
- No tracheal compression on imaging
- Treated with supraglottoplasty if severe
|
| Vascular Ring |
- Incomplete or complete ring of aortic arch around trachea/esophagus
- Biphasic stridor (louder on exhalation)
- Tracheal compression on lateral CXR or barium swallow at T4 level
- Does NOT improve prone
- Feeding difficulties (esophageal compression)
- Double aortic arch most common type
- Diagnosed by CT angiography or MRI
- Treated surgically (ring division)
|
| Subglottic Hemangioma |
- Biphasic stridor appearing weeks after birth (proliferative phase)
- Beard/facial hemangiomas suggest subglottic involvement
- Steeple sign may be asymmetric on CXR
- Cutaneous hemangiomas often present
- Treated with oral propranolol
- Consider PHACE syndrome workup
|
| Tracheomalacia |
- Weakened tracheal cartilage → dynamic airway collapse
- Predominantly EXPIRATORY stridor
- Barking cough
- Worsens with crying; improves with neck extension
- Associated with esophageal atresia and TE fistula repair
- Worsens with upper respiratory infections
- Dynamic airway fluoroscopy or bronchoscopy for diagnosis
|
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