August 2025
August 2025
| Condition | Characteristic features | Diagnosis |
| Epiglottitis (supraglottitis) | Typically occurs in children >5 years and adolescents; fever, toxic appearance; anxiety out of proportion to degree of respiratory distress; "tripod" and/or "sniffing" posture; drooling | Swollen epiglottis seen at time of endotracheal intubation or, in patients with subacute presentation, by awake flexible fiberoptic laryngoscopy or Swollen epiglottis ("thumb sign") on soft tissue lateral neck radiograph (imaging should not delay airway management in patients with severe respiratory distress) |
| Laryngotracheitis (croup) | Typically occurs in infants and young children up to 3 years old; "barking" cough, stridor | Clinical diagnosis Radiographs not necessary but if obtained, findings include:
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| Bacterial tracheitis | Fever is common but not universal, onset may be indolent or rapid with toxic appearance and poor or no response to inhaled epinephrine | Clinical suspicion; radiographs may show intraluminal membranes and tracheal wall irregularity Diagnosis confirmed by bronchoscopy, but visualization is not necessary in children without significant respiratory distress |
| Uvulitis | Swelling and erythema of the uvula | Clinical diagnosis |
| Foreign body | History of sudden onset of choking (though this history is frequently absent); hoarseness or stridor with laryngeal or upper esophageal foreign body | Clinical suspicion Visualization of radio-opaque foreign body; upper esophageal foreign body may cause distortion or deviation of extrathoracic trachea Diagnosis confirmed by bronchoscopy |
| Retropharyngeal abscess | Typically occurs in young children <4 years old; neck pain, fever, pain with swallowing; drooling; unwillingness to move the neck; trismus; midline or unilateral swelling of posterior pharyngeal wall | Clinical suspicion; widening of the retropharyngeal space and reversal of the normal cervical spine curvature Diagnosis confirmed by contrast-enhanced CT |
| Peritonsillar abscess | Typically occurs in older children and adolescents; drooling; trismus; muffled voice; tonsillar swelling with deviation of the uvula | Clinical diagnosis |
| Angioedema | Rapid onset without prodromal viral illness; swelling of lips and tongue; urticarial rash; dysphagia without hoarseness; possible history of previous attack | Clinical diagnosis |
| Congenital anomalies (eg, laryngeal web, laryngomalacia) | Generally have a chronic course and lack systemic symptoms (unless airway narrowing is exacerbated by concomitant infection) | Clinical suspicion Diagnosis confirmed by flexible fiberoptic laryngoscopy and bronchoscopy |
| Respiratory diphtheria | Gradual onset of symptoms: sore throat, malaise, and low-grade fever; presence of diphtheritic membrane | Clinical diagnosis |
| Thermal or chemical injury | History of exposure; lack of fever or prodromal illness with onset of severe respiratory distress | As for epiglottitis above |
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