Radiologic Evaluation of Airway Pathology Prior to Anesthetic Intervention

Airway management remains one of the most critical responsibilities in anesthetic practice, with successful outcomes depending largely on accurate preoperative assessment of airway anatomy and pathology. Structural abnormalities involving the upper or lower airway may substantially increase the risk of difficult ventilation, tracheal intubation, and perioperative respiratory complications. Although bedside airway assessment continues to serve as the initial screening approach, its ability to identify deep or complex anatomical abnormalities is limited. Radiologic imaging has emerged as an important adjunct by providing detailed visualization of airway structures, facilitating more comprehensive evaluation before anesthetic intervention. Advances in imaging technologies have expanded the role of computed tomography, magnetic resonance imaging, and ultrasonography in perioperative airway assessment. Computed tomography offers excellent spatial resolution for identifying airway narrowing, tracheal deviation, tumors, traumatic injuries, and congenital abnormalities, while three-dimensional reconstruction improves understanding of complex anatomical relationships. Magnetic resonance imaging provides superior soft tissue characterization, making it valuable for evaluating masses, inflammatory conditions, and vascular lesions affecting the airway. Point-of-care ultrasonography has gained increasing acceptance because of its portability, absence of ionizing radiation, and ability to identify airway landmarks, estimate airway dimensions, and assist with airway-related procedures in real time. The incorporation of radiologic findings into pre-anesthetic evaluation enhances risk stratification and supports individualized airway management strategies based on patient-specific anatomy. Imaging contributes to the selection of appropriate airway devices, planning of awake or advanced intubation techniques, and preparation for potential airway rescue interventions. Despite the benefits of advanced imaging, interpretation should remain integrated with clinical assessment, patient history, and procedural requirements to ensure optimal decision-making. Continued technological developments and wider availability of imaging modalities are expected to strengthen perioperative airway evaluation, improve patient safety, and reduce the incidence of unexpected difficult airway management across a broad range of surgical and critical care settings.