acute laryngotracheobronchitis

School ager
with stridorAP + lateral radiographs of the airway show narrowing of the subglottic trachea (steeple sign) and overdistension of the hypopharynx.The diagnosis was croup.
pediatricimaging.org • CC-by-nc-sa 4.0
Infant with
stridor and a barky cough. AP radiograph of the airway (left) shows loss of the normal shoulders of the subglottic trachea (steeple sign). Lateral radiograph of the airway (right) shows distension of the hypopharynx, a normal epiglottis and some narrowing of the subglottic trachea. The diagnosis was croup.
pediatricimaging.org • CC-by-nc-sa 4.0
Toddler with
stridor and a barky cough. Endoscopic image of the airway shows mild sublglottic edema. The diagnosis was croup.
pediatricimaging.org • CC-by-nc-sa 4.0
Toddler with
stridor. AP radiograph of the airway (right) shows symmetric subglottic narrowing of the trachea leading to loss of the normal shoulders of the subglottic trachea (church steeple sign). AP radiograph of a normal airway for comparison (left) shows the normal shoulders of the subglottic trachea.The diagnosis was croup.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Croup, also known as acute laryngotracheobronchitis, is due to viral infection of the upper airway by parainfluenza virus or respiratory syncytial virus (RSV).

Although imaging findings are not required for the diagnosis, classic findings of narrowing of the subglottic airway and dilatation of the hypopharynx are supportive of the diagnosis.

Epidemiology

Croup can happen in children as young as 6 months up to 15 years old, but most commonly between 6 months to 3 years with a peak at 18 months. It is the most common cause of upper respiratory distress in infants and young children which usually occurs in late fall to early winter .

Clinical presentation

Clinically it presents with protracted barking cough and inspiratory stridor due to mucosal edema resulting in tracheal narrowing.

Radiographic features

Plain radiograph

Plain radiographs are not always required, as the diagnosis is often made clinically. They are usually obtained to exclude other causes of a similar presentation. Typical radiographic findings include:

  • steeple sign (also known as "wine bottle sign"): seen on AP radiographs of the neck or chest and neck demonstrates uniform narrowing of the subglottic airway
  • distension of hypopharynx is also seen due to the patient's attempt at decreasing airway resistance
  • lateral radiograph of the upper airway will show a normal epiglottis and narrowing of the subglottic region

Treatment and prognosis

Croup is usually self-limiting and has a good overall long-term prognosis.

Treatment is directed toward improving air exchange. Conservative measures, including nebulised epinephrine (epinephrine) and corticosteroids, are commonly used.

Differential diagnosis

General imaging differential considerations include:

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Pseudokrupp:
Epiglottitis
 
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