High-Resolution Ultrasound in the Evaluation of Pediatric Recurrent Respiratory Papillomatosis

Objectives To characterize the ultrasonographic appearance of laryngeal papillomatosis and to compare ultrasound with direct laryngoscopy and bronchoscopy, the criterion standard, for airway evaluation. Design Prospective, nonrandomized analysis of preoperative and postoperative airway ultrasound images. Setting Tertiary, university-based medical center. Participants Eight patients (4 females and 4 males) with recurrent respiratory papillomatosis, with a mean age of 10.25 years and a mean of 14 surgical papilloma resections (range, 3-35). Intervention The patients underwent planned papilloma resections with ultrasound evaluation before formal endoscopic resection. Preresection ultrasound images of respiratory papillomas were evaluated. Main Outcome Measures The ultrasonographic appearance of respiratory papillomas and pediatric airway anatomy. Results Respiratory papillomas appeared as discrete, hyperechoic lesions on the relatively hypoechoic background of the true vocal folds. Conclusions Recurrent respiratory papillomas have a characteristic ultrasonographic appearance that seems to correlate with endoscopic findings. It seems that this modality holds promise for identifying pedunculated papillomas. Although direct laryngoscopy and bronchoscopy are the criterion standard, airway ultrasound may have a role in the early diagnosis of, surveillance of, and operative planning for recurrent respiratory papillomatosis. To our knowledge, this is the first study to describe the ultrasonographic appearance of papillomas and the first comparison of ultrasonographic and endoscopic airway images. This modality merits further study, and further investigation is ongoing.