Bacterial tracheitis

Exudative tracheitis, also known as bacterial tracheitis, membranous croup or membranous laryngotracheobronchitis, is a rare, but potentially life-threatening cause of upper airway obstruction.

Epidemiology

Typical age ranges from 6 to 10 years of age.

Clinical presentation

Clinically it presents with similar symptoms to croup including protracted barking cough and inspiratory stridor, however, will typically present more ill and in an older demographic than for croup (6 months to 3 years of age).

Radiographic features

Plain radiograph

• Linear soft tissue filling defect (membrane) within the upper airway. Linear non-adherent mucus may mimic a membrane on plain film. In cooperative patients repeating the film after coughing can help to differentiate the two. 
• Plaque-like irregularity of the tracheal wall is highly suspicious for exudative tracheitis.
• Subglottic narrowing (steeple sign) in a patient too old to have croup.
• Irregularity and ill-definition of the tracheal wall.

Treatment and prognosis

If exudative membrane is sloughed into the tracheal lumen, it can lead to airway occlusion and respiratory arrest.

Children suspected to have exudative tracheitis are often evaluated endoscopically and have the membrane stripped with elective intubation performed.