Croup Differential Diagnoses

  • Author: Germaine L Defendi, MD, MS, FAAP; Chief Editor: Russell W Steele, MD   more...
 
Updated: Oct 5, 2011
 
 

Diagnostic Considerations

Although croup is considered the most common cause of stridor and respiratory distress in the pediatric population, a variety of disorders should be considered in the differential diagnosis, dependent on clinical history and presenting symptoms, including the following:

  • Spasmodic croup
  • Retropharyngeal abscess
  • Subglottic stenosis
  • Angioneurotic edema
  • Allergic reaction
  • Tracheomalacia
  • Laryngeal web
  • Laryngeal papillomatosis
  • Laryngeal hemangioma
  • Subglottic hemangioma
  • Vocal cord paralysis
  • Uvulitis
  • Innominate artery compression
  • Right aortic arch vascular ring
  • Double aortic arch
  • Aberrant subclavian artery
  • Pulmonary artery sling
  • Rarer etiologies in the pediatric population - Laryngeal tuberculosis, neoplasm (compressing trachea), sarcoidosis, Wegener granulomatosis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Germaine L Defendi, MD, MS, FAAP  Associate Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Germaine L Defendi, MD, MS, FAAP is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Coauthor(s)

Antonio Muñiz, MD  Professor of Emergency Medicine and Pediatrics, University of Texas Medical School at Houston; Medical Director of the Pediatric Emergency Department, Children's Memorial Hermann Hospital

Antonio Muñiz, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Medical Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Rona E Molodow, MD, JD  Clinical Professor, Department of Pediatrics, Olive View-UCLA Medical Center

Rona E Molodow, MD, JD is a member of the following medical societies: American Academy of Pediatrics and American Professional Society on the Abuse of Children

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

  1. Benson BE, Baredes S, Schwartz RA. Stridor. Medscape Reference by WebMD [serial online]. January 26, 2010;Accessed October 5, 2011. Available at http://emedicine.medscape.com/article/995267-overview.

  2. Williams JV, Harris PA, Tollefson SJ, Halburnt-Rush LL, Pingsterhaus JM, Edwards KM, et al. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med. Jan 29 2004;350(5):443-50. [Medline]. [Full Text].

  3. Segal AO, Crighton EJ, Moineddin R, Mamdani M, Upshur RE. Croup hospitalizations in Ontario: a 14-year time-series analysis. Pediatrics. Jul 2005;116(1):51-5. [Medline].

  4. Bernstein T, Brilli R, Jacobs B. Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. Sep 1998;27(3):458-62. [Medline].

  5. Donnelly BW, McMillan JA, Weiner LB. Bacterial tracheitis: report of eight new cases and review. Rev Infect Dis. Sep-Oct 1990;12(5):729-35. [Medline].

  6. Edwards KM, Dundon MC, Altemeier WA. Bacterial tracheitis as a complication of viral croup. Pediatr Infect Dis. Sep-Oct 1983;2(5):390-1. [Medline].

  7. Jones R, Santos JI, Overall JC Jr. Bacterial tracheitis. JAMA. Aug 24-31 1979;242(8):721-6. [Medline].

  8. Johnson D. Croup. Clin Evid (Online). Mar 10 2009;2009:[Medline]. [Full Text].

  9. [Guideline] Alberta Medical Association. Guideline for the diagnosis and management of croup. Alberta Clinical Practice Guidelines 2005 Update. [Full Text].

  10. Kirks DR. The respiratory system. In: Practical Pediatric Imaging: Diagnostic Radiology of Infants and Children. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1998:651-53.

  11. Bjornson C, Russell KF, Vandermeer B, Durec T, Klassen TP, Johnson DW. Nebulized epinephrine for croup in children. Cochrane Database Syst Rev. Feb 16 2011;CD006619. [Medline].

  12. [Best Evidence] Scolnik D, Coates AL, Stephens D, Da Silva Z, Lavine E, Schuh S. Controlled delivery of high vs low humidity vs mist therapy for croup in emergency departments: a randomized controlled trial. JAMA. Mar 15 2006;295(11):1274-80. [Medline].

  13. Colletti JE. Myth: Cool mist is an effective therapy in the management of croup. CJEM. Sep 2004;6(5):357-8. [Medline].

  14. Humidified air inhalation for treating croup [database online]. Cochrane Database of Systematic Reviews; 2006.

  15. Moore M, Little P. Humidified air inhalation for treating croup: a systematic review and meta-analysis. Fam Pract. Sep 2007;24(4):295-301. [Medline].

  16. Bjornson CL, Klassen TP, Williamson J, Brant R, Mitton C, Plint A, 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].

  17. Cetinkaya F, Tüfekçi BS, Kutluk G. A comparison of nebulized budesonide, and intramuscular, and oral dexamethasone for treatment of croup. Int J Pediatr Otorhinolaryngol. Apr 2004;68(4):453-6. [Medline].

  18. Chub-Uppakarn S, Sangsupawanich P. A randomized comparison of dexamethasone 0.15 mg/kg versus 0.6 mg/kg for the treatment of moderate to severe croup. Int J Pediatr Otorhinolaryngol. Mar 2007;71(3):473-7. [Medline].

  19. Fifoot AA, Ting JY. Comparison between single-dose oral prednisolone and oral dexamethasone in the treatment of croup: a randomized, double-blinded clinical trial. Emerg Med Australas. Feb 2007;19(1):51-8. [Medline].

  20. Russell K, Wiebe N, Saenz A, Ausejo SM, Johnson D, Hartling L, et al. Glucocorticoids for croup. Cochrane Database Syst Rev. 2004;CD001955. [Medline].

  21. Amir L, Hubermann H, Halevi A, Mor M, Mimouni M, Waisman Y. Oral betamethasone versus intramuscular dexamethasone for the treatment of mild to moderate viral croup: a prospective, randomized trial. Pediatr Emerg Care. Aug 2006;22(8):541-4. [Medline].

  22. Sparrow A, Geelhoed G. Prednisolone versus dexamethasone in croup: a randomised equivalence trial. Arch Dis Child. Jul 2006;91(7):580-3. [Medline]. [Full Text].

  23. McGee DL, Wald DA, Hinchliffe S. Helium-oxygen therapy in the emergency department. J Emerg Med. May-Jun 1997;15(3):291-6. [Medline].

  24. Vorwerk C, Coats TJ. Use of helium-oxygen mixtures in the treatment of croup: a systematic review. Emerg Med J. Sep 2008;25(9):547-50. [Medline].

  25. Beckmann KR, Brueggemann WM Jr. Heliox treatment of severe croup. Am J Emerg Med. Oct 2000;18(6):735-6. [Medline].

  26. Terregino CA, Nairn SJ, Chansky ME, Kass JE. The effect of heliox on croup: a pilot study. Acad Emerg Med. Nov 1998;5(11):1130-3. [Medline].

  27. Weber JE, Chudnofsky CR, Younger JG, Larkin GL, Boczar M, Wilkerson MD, et al. A randomized comparison of helium-oxygen mixture (Heliox) and racemic epinephrine for the treatment of moderate to severe croup. Pediatrics. Jun 2001;107(6):E96. [Medline].

  28. [Best Evidence] Vorwerk C, Coats T. Heliox for croup in children. Cochrane Database Syst Rev. Feb 17 2010;CD006822. [Medline].

  29. Dobrovoljac M, Geelhoed GC. 27 years of croup: an update highlighting the effectiveness of 0.15 mg/kg of dexamethasone. Emerg Med Australas. Aug 2009;21(4):309-14. [Medline].

 
Previous
Next
 
Child with croup. Note the steeple or pencil sign of the proximal trachea evident on this anteroposterior film. Courtesy of Dr. Kelly Marshall, CHOA at Scottish Rite.
Steeple sign on radiograph.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.