Diagnostic Considerations
Croup is part of the differential diagnosis of epiglottitis. The age of the patient, prodrome, type of cough, and degree of toxicity can all contribute to differentiation of epiglottitis from severe croup. Usually, croup occurs in younger children and has a viral prodrome. Most importantly, the child with croup has a barking cough and rarely appears toxic. A study by Lee et al compared the clinical characteristics of croup and epiglottitis in Korean Emergency Department patients and found that epiglottitis patients experienced dyspnea, sore throat, and vomiting more often than croup patients. [14]
Bacterial tracheitis can also mimic severe croup or epiglottitis. Other conditions to consider include the following:
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Angioneurotic edema
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Anaphylaxis
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Caustic ingestion
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Laryngeal fracture, stenosis, tuberculosis, tumor, hemangioma
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Pertussis
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Pharyngitis
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Pneumonia
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Peritonsillar Abscess
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Retropharyngeal Abscess
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Uvulitis
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Vocal cord paralysis
See also Epiglottitis and Emergent Management of Pediatric Epiglottitis.
Differential Diagnoses
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Swollen epiglottis with characteristic thumbprint sign.
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Comparison of a normal pediatric airway (bottom) and airway from a child who died from epiglottitis (top).
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Child assuming the sniffing position with upper airway obstruction.
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Swollen epiglottis with characteristic thumbprint sign.
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Radiograph of a child with acute epiglottitis; note the hypopharyngeal dilatation, obliteration of the vallecula, and thickened aryepiglottic folds—a positive thumb sign.
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Correct positioning for a cricothyroid needle insertion
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Child with acute epiglottitis after intubation. Note cherry red epiglottis. This image was taken in 2008 and the child was completely immunized and grew HiB from surface culture.
