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Snapshot
  • A 4-year-old boy presents to the emergency room for a cough. His mom reports that he has had this cough for about a day along with fevers, runny nose, and a hoarse voice. He started having some difficulty breathing this afternoon, so his mother brought him to the emergency room. On physical exam, he has a deep barking cough, use of accessory muscles, and inspiratory stridor. He is sent for a chest radiograph, which showed a positive steeple sign. He is immediately given nebulized epinephrine and a dose of steroids. The physician reassures the patient’s mother that this will likely resolve without any complications.
Introduction
  • Clinical definition
    • upper respiratory infection characterized by barking cough
  • Epidemiology
    • incidence
      • common
    • demographics
      • children < 6 years of age
      • boys > girls
  • Etiology
    • parainfluenza virus (most common)
      • paramyxovirus
        • RNA virus
    • influenza virus
      • orthomyxovirus
        • RNA virus
  • Pathogenesis
    • the virus causes inflammation of the upper airway
      • edema, epithelial necrosis, and infiltration of inflammatory cells
      • this causes narrowing of subglottic airway, resulting in stridor and increased work of breath
  • Associated conditions
    • bronchiolitis
  • Prognosis
    • most cases resolve without complications
Presentation
  • Symptoms
    • “seal-like” deep barking cough
    • difficulty breathing
    • sore throat
    • hoarseness
    • congestion
    • symptoms are worse at night
  • Physical exam
    • fever
    • inspiratory stridor
    • tachypnea
    • accessory muscle use
    • pulsus paradoxus with severe croup and upper airway obstruction
Imaging
  • Chest radiography
    • indication
      • all patients
    • findings
      • may show a steeple sign indicating subglottic narrowing 
Studies
  • Making the diagnosis
    • based on clinical presentation
Differential
  • Acute epiglottitis
    • distinguishing factors
      • patients typically have muffled voice, drooling, high fever, and have dysphagia
      • a medical emergency
      • absence of barking cough
Treatment
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • supplemental oxygen
        • hydration
  • Medical
    • single dose of steroids
      • indication
        • all patients
    • nebulized epinephrine
      • indications
        • all patients
Complications
  • Respiratory failure
  • Pneumonia
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