Croup (Laryngotracheitis)

OVERVIEW

Croup (laryngotracheitis) refers to an infectious condition that is characterized by inflammation of the vocal cords, larynx, and trachea.

Source
Source
WHAT CAUSES IT?

Many different viruses can be responsible for causing Croup including: parainfluenza, influenza, adenovirus, RSV, etc.

WHAT MAKES US SUSPECT IT?

Initial Presentation:

  • Barking cough
  • Hoarse voice
  • Stridor
  • Fever

Physical Exam:

Vitals may reveal:

  • Fever
  • Increased respiration rate

Respiratory exam: 

  • Barking cough
  • Hoarse voice/cry
  • Stridor
  • Signs of respiratory distress (flaring nostrils, belly breathing, increased respiratory effort)
CLINICAL WORKUP

The diagnosis of this condition is generally made from the history, physical, and response to treatment.

  • The characteristic “barking cough” of croup may often be sufficient to earn a patient the diagnosis

X-ray imaging may show the “steeple” sign where subglottic tracheal naorrowing produces an outline charactersitic of a church steeple.

Chest X-ray in a child with croup that shows the charactersitic "steeple sign" marked by the arrow (source)
Chest X-ray in a child with croup that shows the charactersitic “steeple sign” marked by the arrow (source)

 

**Specific diagnostic testing for the causal virus seems to have questionable clinical utility. 

WHAT ARE WE WORRIED ABOUT?

Respiratory distress: inflammation of the upper airway structures in croup can cause significant respiratory distress in some cases

HOW DO WE TREAT IT?

Conservative treatments can include measures that relieve the airway symptoms experienced by the patient:

  • Using a humidifier
  • Inhalation of cold mist (i.e. sitting in bathroom with hot shower running while the window is open bringing in cold air)
  • Cough medications

Corticosteroids such as dexamethasone can be given for this condition.

For more severe conditions corticosteroids and nebulizeed epinephrine can be given together.

ARCHIVE OF STANDARDIZED EXAM QUESTIONS 

This archive compiles standardized exam questions that relate to this topic.

 

Page Updated: 11.21.2016