Diagnostic Considerations

Although croup is considered the most common cause of stridor and respiratory distress in the pediatric population, diagnostic differentials should be considered, dependent on clinical history and presenting symptoms, and include the following:

Spasmodic croup (recurrent croup, afebrile)
Retropharyngeal abscess
Subglottic stenosis
Angioedema
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
Gastroesophageal reflux (diagnostic consideration for recurrent croup)
Rarer etiologies in the pediatric population:
- Laryngeal tuberculosis, neoplasm (compressing trachea), sarcoidosis, Wegener granulomatosis

Differential Diagnoses

Workup

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Media Gallery

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.

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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, 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, American Professional Society on the Abuse of Children

Disclosure: Nothing to disclose.

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.

Acknowledgements

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.

Croup Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

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