Laboratory and Imaging Studies

Laboratory studies

Obtain bacterial culture and Gram staining of tracheal secretions and blood cultures in patients with suspected bacterial tracheitis.

Imaging studies

Radiography of the neck may be indicated. Note the following:

Neither definitive nor essential
Portable, not in the radiology suite, only in the stable patient
May reveal subglottic narrowing on anteroposterior (AP) views - Steeple sign, similar to croup (See the image below.)

Steeple sign.
May reveal clouding of tracheal air column or irregular tracheal margin on lateral view
Concretions of epithelium and inflammatory cells possibly mimicking a foreign body

Procedures

Laryngotracheobronchoscopy is indicated. Note the following:

Only definitive means of diagnosis
Direct visualization and culture of purulent tracheal secretions
May be therapeutic by performing tracheal toilet and stripping purulent membranes
Pediatric-sized bronchoscopes and experts at pediatric airway management not available at all facilities

Treatment & Management

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Media Gallery

Steeple sign.

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Author

Sujatha Rajan, MD Assistant Professor of Pediatrics, Albert Einstein School of Medicine; Consulting Staff, Department of Pediatrics, Division of Pediatric Infectious Diseases, Schneider Children's Hospital, North Shore-Long Island Jewish Health System

Sujatha Rajan, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Coauthor(s)

Kathryn Clark Emery, MD Associate Professor, Department of Pediatrics, University of Colorado Health Sciences Center; Consulting Staff, Department of Emergency Medicine, Children's Hospital of Denver

Kathryn Clark Emery, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Sunil K Sood, MBBS, , MD Professor of Clinical Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine; Chief, Pediatric Infectious Diseases, Firm Director, Pediatric Unit, Schneider Children's Hospital at North Shore, North Shore University Hospital

Sunil K Sood, MBBS, , MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

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, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

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, Southern Medical Association

Disclosure: Nothing to disclose.