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Croup can be caused by a number of viruses including parainfluenza and influenza virus. [2] Rarely is it due to a bacterial infection. [5] Croup is typically diagnosed based on signs and symptoms after potentially more severe causes, such as epiglottitis or an airway foreign body, have been ruled out. [4]
Epiglottitis is the inflammation of the epiglottis—the flap at the base of the tongue that prevents food entering the trachea (windpipe). [7] Symptoms are usually rapid in onset and include trouble swallowing which can result in drooling, changes to the voice, fever, and an increased breathing rate.
The diagnosis of tracheitis requires the direct vision of exudates or pseudomembranes on the trachea. X-ray findings may include subglottic narrowing. The priority is to secure the patient's airway, and to rule out croup and epiglottitis which may be fatal.
In children, viral infections such as croup or epiglottitis are frequent causes. [4] Adults are more likely to experience obstruction from enlargement of the tonsils or vocal cord paralysis. [3] Obstructive sleep apnea is the most common chronic cause of upper airway obstruction. [2]
In radiology, the thumbprint sign, or thumbprinting, is a radiologic sign found on a radiograph that suggests the diagnosis of either epiglottitis or intestinal ischemia.. In a lateral C-spine radiograph, the sign is caused by a thickened free edge of the epiglottis, which causes it to appear more radiopaque than normal, resembling the distal thumb.
[1] [3] [5] In the pediatric setting, the reported most common causes of NPPE are both infectious in nature: croup and epiglottitis. [1] Other reported causes include endotracheal tube obstruction (e.g., from patient biting down on tube), tumors/masses compressing the upper airway, choking on foreign objects, strangulation.
[1] [2] The presence of the steeple sign supports a diagnosis of croup, usually caused by paramyxoviruses. [3] It can also be defined as the replacement of the usual squared-shoulder appearance of the subglottic area by cone-shaped narrowing just distal to the vocal cords. This is called the steeple or pencil-point sign.
Inspiratory stridor often occurs in children with croup. It may be indicative of serious airway obstruction from severe conditions such as epiglottitis, a foreign body lodged in the airway, or a laryngeal tumor. Stridor should always command attention to establish its cause.