A child presents with a barking cough and inspiratory stridor. Neck radiographs show subglottic narrowing. This finding is most consistent with which condition?

A child presents with a barking cough and inspiratory stridor. Neck radiographs show subglottic narrowing. This finding is most consistent with which condition?

• A. Bronchiolitis
• B. Epiglottitis
• C. Croup
• D. Foreign body aspiration

Answer: (C)

This presentation reflects inflammation of the larynx and subglottic airway in a young child, which causes a barking cough and inspiratory stridor. The subglottic region is the narrowest part of the pediatric airway, so edema here leads to audible stridor on inspiration and sometimes visible respiratory distress. On neck radiographs, this edema often appears as subglottic narrowing, classically described as a steeple sign. This combination is characteristic of viral croup (laryngotracheitis). Bronchiolitis would more often show wheezing and signs of lower airway involvement like diffuse hyperinflation. Epiglottitis presents with severe toxicity, drooling, and a muffled voice, with a thumbprint sign on lateral neck radiographs. Foreign body aspiration usually has a sudden onset of coughing with unilateral breath sounds or localized wheeze.

This presentation reflects inflammation of the larynx and subglottic airway in a young child, which causes a barking cough and inspiratory stridor. The subglottic region is the narrowest part of the pediatric airway, so edema here leads to audible stridor on inspiration and sometimes visible respiratory distress. On neck radiographs, this edema often appears as subglottic narrowing, classically described as a steeple sign. This combination is characteristic of viral croup (laryngotracheitis).

Bronchiolitis would more often show wheezing and signs of lower airway involvement like diffuse hyperinflation. Epiglottitis presents with severe toxicity, drooling, and a muffled voice, with a thumbprint sign on lateral neck radiographs. Foreign body aspiration usually has a sudden onset of coughing with unilateral breath sounds or localized wheeze.