Gaseous distention of the hypopharynx and cervical esophagus with nasal CPAP: a mimicker of pharyngeal perforation and esophageal atresia.
BACKGROUND
Nasal continuous positive airway pressure (CPAP) has been used since 1975 as the initial treatment for respiratory distress syndrome (RDS) in very premature infants. Gaseous distention of the abdomen (CPAP belly) is a common secondary effect of CPAP. Gaseous distention of the hypopharynx is also common.


OBJECTIVE
To determine the incidence of hypopharyngeal distention in infants on CPAP.


METHODS
We performed a retrospective review of the chest radiographs of 57 premature infants treated with CPAP during a 4-week period to find the presence and degree of hypopharyngeal distention.


RESULTS
Of the 57 radiographs, 14 (25%) revealed gaseous distention of the hypopharynx and/or cervical esophagus. On occasion, this raised concern for pharyngeal perforation or esophageal atresia.


CONCLUSIONS
Awareness that CPAP-related hypopharyngeal distention is common should help radiologists avoid erroneous consideration of esophageal atresia or hypopharyngeal perforation.
Walor
David
D
Department of Radiology, Children's Hospital of New York, Columbia University Medical Center, 3959 Broadway, New York, NY 10032, USA.
Berdon
Walter
W
Anderson
Nicole
N
Holt
Peter D
PD
Fox
Matthew
M
D045422:Continuous Positive Airway Pressure / Q000009:adverse effects*; D003937:Diagnosis, Differential; D004108:Dilatation, Pathologic / Q000209:etiology; D004933:Esophageal Atresia / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D007013:Hypopharynx / Q000000981:diagnostic imaging / Q000473:pathology*; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D010608:Pharyngeal Diseases / Q000151:congenital / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome