0
Feedback Feedback

<< Management of Airway Obstruction and Stridor in Pediatric Patients

Diagnostic Studies

In the initial management of stridor, laboratory and radiographic data are often low-yield. Rapid viral antigen testing, heterophile antibody testing, and bacterial cultures may identify specific organisms in cases of infection; however, results from these tests rarely alter initial management. Most causes of stridor are determined clinically; however, imaging studies can be helpful in establishing a definitive diagnosis in specific instances, or when the diagnosis or response to treatment is unclear or unexpected.2

Radiographic Imaging

X-ray is often the quickest and most readily available imaging modality in the ED. In cases of significant obstruction in an unstable child, an x-ray can be obtained without the child leaving the ED. While croup should be diagnosed clinically and does not require an x-ray for diagnosis, a soft-tissue neck x-ray may be obtained to help assess for other possible diagnoses such as epiglottitis, neck mass, retropharyngeal abscess, or foreign body. The classic x-ray finding in croup is a “steeple” sign caused by narrowing of the subglottic area. However, a negative x-ray does not rule out the diagnosis, as about half of children with a diagnosis of croup have a normal neck x-ray.34,35 Similarly, the steeple sign is not pathognomonic of croup and, thus, does not unequivocally prove its presence. Epiglottitis has a classic lateral x-ray finding of an enlarged, thickened epiglottis called the “thumbprint” sign.30,36 (See Figure 2.) Maintain a high level of suspicion for epiglottis in a child presenting with drooling, agitation, and no cough. However, given the relatively low incidence of epiglottitis in cases of stridor, radiographs are often obtained to confirm the diagnosis in a stable child.37 Among children with bacterial tracheitis, a lateral neck x-ray may show nonspecific subglottic narrowing or irregularities of the anterior wall known as the “candle dripping” sign.28

To continue reading, please log in or purchase access.

Already purchased this course?
Log in to read.
Purchase a subscription

Price $319/year

+4 Credits!

Purchase Issue & CME Test

Price $39

+4 Credits!

Money-back Guarantee
Get Quick-Read Evidence-Based Updates
Enter your email to get free evidence-based content delivered to your inbox once per month.
Please provide a valid email address.