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Pediatrics, Croup or Laryngotracheobronchitis: Differential Diagnoses & Workup
Updated: Aug 11, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Diphtheria
Foreign Bodies, Gastrointestinal
Foreign Bodies, Trachea
Pediatrics, Epiglottitis
Pediatrics, Foreign Body Ingestion
Other Problems to Be Considered
Subglottic stenosis
Retropharyngeal abscess
Subglottic hemangioma
Workup
Laboratory Studies
- Laboratory testing for laryngotracheobronchitis (ie, croup) is not usually needed in well-hydrated patients.
- If laboratory tests are needed, they should be deferred while the patient is in distress.
- Approximately 80% of admitted patients are hypoxic.
- A pulse oximetry measurement is indicated in all but the mildest cases.
- In the usual case, hypoxia is caused by pulmonary involvement.
- With severe airway obstruction, respiratory failure may occur.
- A CBC count is indicated.
- Leukopenia in early stage of illness
- Leukocytosis in later stage of patients with severe disease
Imaging Studies
- Imaging tests are not required in mild cases with typical history that respond appropriately to treatment.
- An anteroposterior (AP) soft tissue neck radiograph may show subglottic narrowing.
- The usual squared-shoulder appearance of the subglottic area is replaced by cone shaped narrowing just distal to the vocal cords. This is called the steeple or pencil-point sign.
- Monitor patients during imaging because progression of airway obstruction may be rapid.
Other Tests
- Rapid antigen tests are available in some centers but usually are not needed.
Procedures
- Direct laryngoscopy if the child in not in acute distress
- Fiberoptic laryngoscopy
- Bronchoscopy
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Differential Diagnoses & Workup: Pediatrics, Croup or Laryngotracheobronchitis |
| Treatment & Medication: Pediatrics, Croup or Laryngotracheobronchitis |
| Follow-up: Pediatrics, Croup or Laryngotracheobronchitis |
| Multimedia: Pediatrics, Croup or Laryngotracheobronchitis |
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References
Johnson DW. Croup. Clin Evid (Online). Mar 10 2009;2009:[Medline].
[Guideline] Mazza D, Wilkinson F, Turner T, Harris C. Evidence based guideline for the management of croup. Aust Fam Physician. Jun 2008;37(6 Spec No):14-20. [Medline].
Bjornson CL, Klassen TP, Williamson J, et al. A randomized trial of a single dose of oral dexamethasone for mild croup. N Engl J Med. Sep 23 2004;351(13):1306-13. [Medline].
Connors K, Gavula D, Terndrup T. The use of corticosteroids in croup: a survey. Pediatr Emerg Care. Aug 1994;10(4):197-9. [Medline].
Dawson KP, Steinberg A, Capaldi N. The lateral radiograph of neck in laryngo-tracheo-bronchitis (croup). J Qual Clin Pract. Mar 1994;14(1):39-43. [Medline].
Eitzen EM. Croup, epiglottis, and bacterial tracheitis. In: Rosen, ed. Emergency Medicine: Concepts and Clinical Practice. 4th ed. 1998:1123.
Geelhoed GC, Macdonald WB. Oral and inhaled steroids in croup: a randomized, placebo-controlled trial. Pediatr Pulmonol. Dec 1995;20(6):355-61. [Medline].
Geelhoed GC, Macdonald WB. Oral dexamethasone in the treatment of croup: 0.15 mg/kg versus 0.3 mg/kg versus 0.6 mg/kg. Pediatr Pulmonol. Dec 1995;20(6):362-8. [Medline].
Johnson DW, Schuh S, Koren G, Jaffee DM. Outpatient treatment of croup with nebulized dexamethasone. Arch Pediatr Adolesc Med. Apr 1996;150(4):349-55. [Medline].
Kelley PB, Simon JE. Racemic epinephrine use in croup and disposition. Am J Emerg Med. May 1992;10(3):181-3. [Medline].
Klassen TP, Rowe PC. Outpatient management of croup. Curr Opin Pediatr. Oct 1996;8(5):449-52. [Medline].
Kunkel NC, Baker MD. Use of racemic epinephrine, dexamethasone, and mist in the outpatient management of croup. Pediatr Emerg Care. Jun 1996;12(3):156-9. [Medline].
Leung AK, Kellner JD, Johnson DW. Viral croup: a current perspective. J Pediatr Health Care. Nov-Dec 2004;18(6):297-301. [Medline].
Orenstein DM. Acute inflammatory upper airway obstruction. In: Behman, ed. Nelson Textbook of Pediatrics. 15th ed. 1996:1201.
Rittichier KK, Ledwith CA. Outpatient treatment of moderate croup with dexamethasone: intramuscular versus oral dosing. Pediatrics. Dec 2000;106(6):1344-8. [Medline].
Further Reading
Keywords
croup, laryngotracheobronchitis, viral infection of the upper respiratory tract, airway obstruction, parainfluenza type 1, parainfluenza type 2, parainfluenza type 3, upper respiratory infection, URI, paramyxovirus, influenza virus type A, respiratory syncytial virus, RSV, adenovirus, rhinovirus, enterovirus, coxsackievirus, enteric cytopathogenic human orphan virus, ECHO virus, reovirus, measles virus, barking cough, viral infection
Differential Diagnoses & Workup: Pediatrics, Croup or Laryngotracheobronchitis