A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia

Sanchez, M. O., Greer, M. C., Masters, I. B. and Chang, A. B. (2012) A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia. Pediatric Pulmonology, 47 1: 63-67. doi:10.1002/ppul.21517

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Author Sanchez, M. O.
Greer, M. C.
Masters, I. B.
Chang, A. B.
Title A comparison of fluoroscopic airway screening with flexible bronchoscopy for diagnosing tracheomalacia
Journal name Pediatric Pulmonology   Check publisher's open access policy
ISSN 8755-6863
Publication date 2012-01
Year available 2011
Sub-type Article (original research)
DOI 10.1002/ppul.21517
Volume 47
Issue 1
Start page 63
End page 67
Total pages 4
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Collection year 2012
Language eng
Formatted abstract
Flexible bronchoscopy (FB) is the gold standard method of diagnosing tracheomalacia but it is not always feasible in settings with limited resources. Fluoroscopy is sometimes performed as an alternative diagnostic tool but there are no prospective studies that have evaluated the diagnostic accuracy of airway fluoroscopy for tracheomalacia using a-priori definitions. We determined the sensitivity, specificity, and likelihood predictive ratio of airway fluoroscopy compared with FB in children suspected of having an airway abnormality.


Airway fluoroscopic examination was undertaken within 2-weeks of a FB in children aged <18-years and reported by a pediatric radiologist blinded to FB data. Fluoroscopic and FB methods and diagnostic criteria were standardized and defined a-priori. Tracheomalacia diagnosed by FB were independently scored (mild, moderate, severe) by 2 pulmonologists in a blinded manner.

In 22 children (median age 33 months, range 1–187) evaluated for airway abnormality, tracheomalacia was found in 21 children at bronchoscopy. Of these, fluoroscopy detected tracheomalacia in five children. Airway fluoroscopy was poorly sensitive (23.8%) but highly specific (100%), positive likelihood ratio was 8.6. However, in moderate-severe tracheomalacia, the sensitivity improved to 57.1% but the specificity reduced (93.3%). The agreement between bronchoscopists for tracheomalacia severity was excellent, weighted kappa 0.74 (95% CI 0.77, 0.98).

Airway fluoroscopy cannot replace FB which remains the tool for definitively diagnosing
airway malacia. However, in absence of other modalities for diagnosis fluoroscopy should be considered in the setting of persistent respiratory symptoms compatible with the clinical picture of tracheomalacia.
Keyword Tracheomalacia
Flexible bronchoscopy
Airway fluoroscopy
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Article first published online: 9 AUG 2011

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
Official 2012 Collection
School of Medicine Publications
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Citation counts: TR Web of Science Citation Count  Cited 9 times in Thomson Reuters Web of Science Article | Citations
Scopus Citation Count Cited 8 times in Scopus Article | Citations
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Created: Mon, 19 Dec 2011, 13:22:14 EST by Jane Medhurst on behalf of Child Health Research Centre