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Age: 8 months

Sex: Male

Indication: Stridor

Save ("V")

Case #16


Findings

  • Loss of shouldering of the subglottic airway
  • Ballooning of the hypopharynx


Diagnosis

  • Croup (laryngotracheobronchitis)

Sample Report

Loss of shouldering of the subglottic airway and ballooning of the hypopharynx, likely relating to croup.

No evidence of epiglottitis.

No retropharyngeal thickening.


Discussion

  • Croup is common in children under the age of 3 and most commonly is caused by parainfluenza virus
  • Although it involves much of the airway (hence the name laryngotracheobronchitis), the loose attachment of the conus elasticus in the upper cervical trachea makes this the location most susceptible to airway obstruction
  • Remember that airway obstruction above the thoracic inlet primarily impairs inspiration, whereas airway obstruction below the thoracic inlet primarily impairs expiration
  • Hypopharyngeal overdistension is a common imaging finding in upper airway obstruction, but this can also be seen in normal crying infants if imaged at the precise moment they are gasping for air in between screams


Images

Red arrows: vocal folds. Normal U-shaped or shouldered subglottic airway in a comparison patient on the left and abnormal V-shaped or steepled subglottic airway in this patient with croup on the right. Nondistended pharynx and hypopharynx on the left in a comparison normal patient and abnormal distension on the right in this patient with croup.

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