II. Differential Diagnosis: Child

  1. Foreign Body Aspiration
    1. Rapidly progresses from Choking to Stridor and decreased breath sounds
    2. Partial obstructions may present only as cough
  2. Anaphylaxis
    1. Angioedema, Stridor and Wheezing
    2. Shock onset within minutes to hours
  3. Croup
    1. Barking cough, harsh voice and Stridor developing over days
  4. Epiglottitis
    1. Rapid onset and progression within 24 hours to fever, Pharyngitis, Drooling, muffled voice and no cough
  5. Bacterial Tracheitis
    1. URI symptoms abruptly progressing to high fever, toxic appearance, Stridor and cough
  6. Retropharyngeal Abscess or Peritonsillar Abscess
    1. Fever and Pharyngitis progressing to Drooling and stiff, painful neck
  7. Ludwig's Angina
    1. Dental Infection spread to submaxillary space with secondary fever, Cellulitis, Stridor and Trismus
  8. Diphtheria
    1. Thick, gray, exudative Pharyngitis with fever, Dysphagia and toxic appearance

III. Imaging

  1. Chest XRay (AP, Lateral)
    1. Croup
      1. Steeple sign (secondary to tracheal narrowing and subglottic edema)
    2. Foreign Body Aspiration
      1. Upper airway: Foreign body may be visible, pharynx over-inflated
      2. Lower airway: Air trapping with hyperinflation, Atelectasis
  2. Soft Tissue Neck (Lateral)
    1. Retropharyngeal Abscess
      1. Pre-Vertebral soft tissue thickening or air-fluid level
    2. Epiglottitis
      1. Thumbprint sign (secondary to Epiglottis swelling)

IV. Management

V. References

  1. Fuchs and Yamamoto (2011) APLS, Jones and Bartlett, Burlington, p. 48, 58

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