Croup

Case contributed by Ashesh Ishwarlal Ranchod
Diagnosis certain

Presentation

Stridor, fever, non-productive cough, and irritability.

Patient Data

Age: 15 months
Gender: Male
x-ray
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There is distention of the hypopharynx.

There is adenoidal hypertrophy and palatine tonsillar enlargement.

x-ray
Frontal
Lateral
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There is hyperinflation with a central trachea and a normal cardiomediastinal contour.

There is smooth, subglottic tracheal narrowing.

There is no aspirated radio-opaque foreign body.

Case Discussion

An example of the tracheal steeple sign 1.2. There is smooth, tapered narrowing of the subglottic trachea caused by mucosal oedema, secondary to a viral infection of the upper airway. The narrowed trachea resembles a church steeple. The appearance is also known as the wine bottle sign/pencil tip sign or the inverted V sign 2.

The clinical and radiological differential diagnosis includes:

  • foreign body aspiration

  • epiglottitis

  • upper airway abscess formation

  • angioneurotic oedema

  • tracheal injury/ trauma

  • congenital airway abnormalities including bronchogenic cysts

  • early Guillain-Barre syndrome

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