Airway Disease

There are few conditions in emergency medicine as potentially challenging and high risk as the acute airway obstruction. Time is often limited, the patient’s condition may be critical, and a failed airway has the potential for significant morbidity or death. Chest radiography (CXR) is useful in diagnosing and evaluating the progression of atelectasis, aspiration, pulmonary edema, pneumonia, and pleural fluid collections. Lung ultrasonography (LUS) is an excellent complementary diagnostic tool in emergency diagnosis. For patients who can tolerate lying flat for the study, thin-section multidetector computed tomography (MDCT) provides the anatomic detail that permits planning of therapy and is useful when the clinical and radiologic presentations are discrepant and the patient is not responding to therapy or in further defining a radiographic abnormality. Imaging plays a key role in the diagnosis and monitoring of bronchiectasis and the management of complications. Exacerbation of bronchiectasis can confer substantial potential morbidity, usually secondary to recurrent infection. In severe cases of bronchiectasis, massive hemoptysis can lead to death. CXR is useful as an initial screening tool and during acute exacerbations, but has limited sensitivity and specificity. Thin-section MDCT is the reference standard for diagnosis and quantification of bronchiectasis, providing detailed morphological informations. Radiologists must know various causes of bronchiectasis, including common causes, such as recurrent infection or aspiration, and uncommon causes, such as congenital immunodeficiencies and disorders of cartilage development. In industrialized countries, inhalational exposures to various toxicants are commonplace. Most acute toxic inhalations come from industries, home, and recreational sources. In addition to individual susceptibility, the characteristics of inhaled substances such as water solubility, size of substances, and chemical properties may affect disease severity as well as its location. A detailed history becomes even more important in such a patient and may help make a difference in the often chaotic setting of the emergency department. Laboratory evaluation, arterial blood gas analysis, and supportive measures, including the ABCs (airway, breathing, and circulation), may be required. Unfortunately, the varied presentations result in a nonspecific clinical syndrome and make diagnosis somewhat difficult. Despite substantial limitations, imaging can help in showing diffuse interstitial, alveolar, or mixed infiltrates, segmental consolidation, hyperinflation, pneumothorax, and pleural effusion. Thin-section MDCT can be used to further characterize lung abnormalities and continues to demonstrate previously unidentified characteristics that shape our understanding of noxious inhaled toxicant injury.