An 18-month-old baby girl is bought to the emergency department by her parents, as they are concerned about her noisy breathing. She has had a mild cough for the last 24 h and her temperature is elevated. She is up to date with her vaccinations and has had no developmental problems. There is no other relevant history.
On Examination : Her oxygen saturation is 94 per cent on air. The baby is restless and has a hoarse cry. There is an audible stridor at rest. The baby has a low-grade fever with a mildly increased respiratory rate. There is no evidence of cyanosis. Auscultation of the chest is difficult but there is an audible inspiratory noise.
Q. 1. What is the differential diagnosis ?
Ans :- In this case the two most likely diagnoses are croup (acute laryngo-tracheo-bronchitis) or acute epiglottitis. Laryngo-tracheo-bronchitis presents in childhood and is usually preceded by an upper respiratory tract infection. The child develops malaise, a high temperature and stridor. The stridor is the result of subglottic oedema which soon spreads to the trachea and bronchi. It is usually caused by a viral infection (parainfluenza). Mild cases of croup often respond to oral steroids. Severe cases may require ventilatory support as well as nebulized adrenaline and inhaled or intravenous steroids.
Q. 2. How do you define stridor ?
Ans :- Stridor is defined as a high-pitched noise caused by turbulent airflow in the larynx or trachea as the result of narrowing of the airway.
Q. 3. What are the causes of stridor ?
Ans :- Common causes of stridor are :
A. Neonate :
• Laryngomalacia/tracheomalacia
• Vocal cord lesion/palsy, e.g. neurological, birth/surgical trauma
• Laryngotracheal stenosis, e.g. congenital
• Airway haemangioma
B. Child :
• Croup
• Acute epiglottitis
• Airway haemangioma
• Foreign body
• Trauma
• Airway compression, e.g. thyroid disease
C. Adult :
• Vocal cord palsy secondary to thyroid or chest surgery
• Acute epiglottitis/supraglottitis
• Laryngeal carcinoma
• Laryngotracheal stenosis, e.g. secondary to endotracheal intubation or heat inhalation
• Inhalation of a foreign body
• Trauma to the anterior neck
• Airway compression by thyroid disease.
On Examination : Her oxygen saturation is 94 per cent on air. The baby is restless and has a hoarse cry. There is an audible stridor at rest. The baby has a low-grade fever with a mildly increased respiratory rate. There is no evidence of cyanosis. Auscultation of the chest is difficult but there is an audible inspiratory noise.
Q. 1. What is the differential diagnosis ?
Ans :- In this case the two most likely diagnoses are croup (acute laryngo-tracheo-bronchitis) or acute epiglottitis. Laryngo-tracheo-bronchitis presents in childhood and is usually preceded by an upper respiratory tract infection. The child develops malaise, a high temperature and stridor. The stridor is the result of subglottic oedema which soon spreads to the trachea and bronchi. It is usually caused by a viral infection (parainfluenza). Mild cases of croup often respond to oral steroids. Severe cases may require ventilatory support as well as nebulized adrenaline and inhaled or intravenous steroids.
Q. 2. How do you define stridor ?
Ans :- Stridor is defined as a high-pitched noise caused by turbulent airflow in the larynx or trachea as the result of narrowing of the airway.
Q. 3. What are the causes of stridor ?
Ans :- Common causes of stridor are :
A. Neonate :
• Laryngomalacia/tracheomalacia
• Vocal cord lesion/palsy, e.g. neurological, birth/surgical trauma
• Laryngotracheal stenosis, e.g. congenital
• Airway haemangioma
B. Child :
• Croup
• Acute epiglottitis
• Airway haemangioma
• Foreign body
• Trauma
• Airway compression, e.g. thyroid disease
C. Adult :
• Vocal cord palsy secondary to thyroid or chest surgery
• Acute epiglottitis/supraglottitis
• Laryngeal carcinoma
• Laryngotracheal stenosis, e.g. secondary to endotracheal intubation or heat inhalation
• Inhalation of a foreign body
• Trauma to the anterior neck
• Airway compression by thyroid disease.
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