Volume 1, Case 10

Drooling, Stridor, and a Barking Cough:  Croup??
Radiology Cases in Pediatric Emergency Medicine
Volume 1, Case 10
Rodney B. Boychuk, M.D.

An 18 month old female presented to the Emergency Department with a history of fever, noisy breathing, a harsh cough, and drooling. The fever and coughing began yesterday, but tonight the fever is higher and the cough sounds very harsh. The sound of this cough was alarming to the parents. The highest temperature measured was 39.5 degrees rectally. She was noted to be drooling more than usual, but this was attributed to teething. Her cry was more raspy than her normal cry. She was not taking in solids well, but she was taking liquids well.

Exam: VS T39.1 degrees rectally, P170, R28, BP 100/66. She appeared alert, awake, not toxic, in no acute distress. She did not appear to prefer an upright or a forward leaning position. Skin was warm & moist, without rash. No head or sinus tenderness were noted. Tympanic membranes were normal. The oral pharynx was clear and the mucosa was moist. Excessive drooling was not noticed by the examiner. The neck was supple with small lymph nodes bilaterally. Heart regular without murmurs. Lungs clear when resting. However, when she was crying, mild inspiratory stridor was noted. An occasional croupy cough was noted. The abdominal exam was unremarkable. Color and perfusion were good. A soft tissue lateral neck radiograph was ordered.

View lateral neck radiograph.

X-ray

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What is your Diagnosis?

 Loren Yamamoto, 
      MD, MPH Associate Professor of Pediatrics University of Hawaii John A. Burns 
      School of Medicine loreny@hawaii.edu