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Pediatr Emerg Care 2018 Aug;34(8):e139-e140

Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN.

Stridor is a common presenting symptom in young children and is produced by turbulent flow through the upper airway or trachea. In children under 12 months of age, stridor is commonly caused by laryngomalacia, tracheomalacia, croup, airway foreign body, and/or retropharyngeal abscess. In atypical presentations of stridor, soft tissue neck radiographs can be helpful to determine the underlying etiology. Read More

Pediatr Emerg Med Pract 2017 Nov 22;14(11 Suppl Points & Pearls):S1-S2. Epub 2017 Nov 22.

Pediatric Emergency Medicine Ultrasound Fellow, Department of Emergency Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA.

Stridor is a result of turbulent air-flow through the trachea from upper airway obstruction, and although in children it is often due to croup, it can also be caused by noninfectious and/or congenital conditions as well as life-threatening etiologies. The history and physical examination guide initial management, which includes reduction of airway inflammation, treatment of bacterial infection, and, less often, imaging, emergent airway stabilization, or surgical management. This issue discusses the most common as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department. Read More

Pediatr Emerg Med Pract 2017 11;14(11):1-24

Associate Professor of Pediatrics and Emergency Medicine; Fellowship Director, Director of Education, Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT

Stridor is a result of turbulent air-flow through the trachea from upper airway obstruction, and although in children it is often due to croup, it can also be caused by noninfectious and/or congenital conditions as well as life-threatening etiologies. The history and physical examination guide initial management, which includes reduction of airway inflammation, treatment of bacterial infection, and, less often, imaging, emergent airway stabilization, or surgical management. This issue discusses the most common as well as the life-threatening etiologies of acute and chronic stridor and its management in the emergency department. Read More

BMJ Case Rep 2017 Sep 12;2017. Epub 2017 Sep 12.

Department of Pediatrics, Hospital de Braga, Braga, Portugal.

Pediatr Radiol 2017 Dec 22;47(13):1745-1750. Epub 2017 Aug 22.

Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.

Background: Human metapneumovirus (HMPV) was identified in 2001 and is a common cause of acute respiratory illness in young children. The radiologic characteristics of laboratory-confirmed HMPV acute respiratory illness in young children have not been systematically assessed.

Objective: We systematically evaluated the radiographic characteristics of acute respiratory illness associated with HMPV in a prospective cohort of pediatric patients. Read More

Pediatrics 2017 Apr 14;139(4). Epub 2017 Mar 14.

Children's Hospital Colorado, Aurora, Colorado.

Background And Objectives: Croup is a clinical diagnosis, and the available evidence suggests that, except in rare cases, ancillary testing, such as radiologic imaging, is not helpful. Given the paucity of inpatient-specific evidence for croup care, we hypothesized that there would be marked variability in the use of not routinely indicated resources (NRIRs). Our primary study objective was to describe the variation and predictors of variation in the use of NRIRs. Read More

Intensive Care Med 2017 04 3;43(4):564-565. Epub 2016 Dec 3.

Department of Emergency Medicine, JR General Hospital, 2-1-3 Yoyogi, Shibuya-Ku, Tokyo, 151-8528, Japan.

Int J Pediatr Otorhinolaryngol 2016 Nov 5;90:86-90. Epub 2016 Sep 5.

Department of Otorhinolaryngology, The University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd WP 1290, Oklahoma City, OK, 73104, USA.

Importance: The etiology of recurrent croup is often anatomic. Currently there is no set criteria for determining who should undergo diagnostic bronchoscopy and which patients are at most risk for having a clinically significant finding. Few studies have addressed these questions. Read More

Phlebology 2017 Aug 6;32(7):453-458. Epub 2016 Jul 6.

1 Department of Clinical Sciences, Lund University, Lund, Sweden.

Background High-quality non-invasive imaging of the deep venous system in the thorax is challenging, but nevertheless required for diagnosis of vascular pathology as well as for patient selection and preoperative planning for endovascular procedures. Purpose To compare the diagnostic quality of Gadofosveset-enhanced thoracic magnetic resonance venography, seven consecutive patients with suspected or known disease affecting the central thoracic veins were compared to seven consecutive magnetic resonance venography using conventional gadolinium-based contrast agents. Materials and methods Diagnostic capability, defined as the ability to assess vessel patency and pathologic conditions, for the major thoracic deep venous segments was assessed by two-independent readers. Read More

Mikrobiyol Bul 2016 Jan;50(1):159-64

Bakırköy Dr. Sadi Konuk Training and Research Hospital, Pediatric Intensive Care Unit, Istanbul, Turkey.

Human bocavirus (HBoV), that was first identified in 2005 and classified in Parvoviridae family, is a small, non-enveloped, single-stranded DNA virus, responsible for upper and lower respiratory tract infections, especially in young children. Although HBoV generally causes self-limited influenza-like illness, it may also lead to pneumonia, bronchiolitis, croup and asthma attacks. In this report, a case of acute bronchiolitis complicated with pneumomediastinum and bilateral pneumothorax caused by HBoV has been presented. Read More

Paediatr Anaesth 2016 May 9;26(5):531-8. Epub 2016 Mar 9.

Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA.

Background: Patients with mucopolysaccharidoses (MPS) are generally considered high risk for anesthesia care, owing to disease-related factors. Sanfilippo syndrome type A (MPS IIIA) is the most frequently occurring MPS. Anesthesia-specific information for MPS IIIA is not readily available in the literature. Read More

Radiographics 2015 Nov-Dec;35(7):2064-79. Epub 2015 Oct 23.

From the Department of Radiology, University of British Columbia, 3350-950 W 10th Ave, Vancouver, BC, Canada V5Z 1M9 (K.E.D., L.K.Y.); Zanvyl Krieger School of Arts and Sciences, Johns Hopkins University, Washington, DC (A.T.R.); and Department of Radiology, British Columbia Children's Hospital, Vancouver, BC, Canada (L.K.Y.).

Acute airway obstruction is much more common in infants and children than in adults because of their unique anatomic and physiologic features. Even in young patients with partial airway occlusion, symptoms can be severe and potentially life-threatening. Factors that predispose children to airway compromise include the orientation of their larynx, the narrow caliber of their trachea, and their weak intercostal muscles. Read More

Adv Emerg Nurs J 2015 Apr-Jun;37(2):79-82

St. Mary Medical Center, Long Beach, California.

Croup, or laryngotracheobronchitis, is a common viral respiratory tract illness seen in the pediatric population (). This article describes the case of a child who presents with croup and the characteristic "steeple sign" seen on the radiograph. The patient received a diagnosis of croup secondary to the parainfluenza virus infection. Read More

Indian J Pediatr 2015 Jul 26;82(7):629-36. Epub 2014 Sep 26.

Department of Pediatric Medicine, S.M.S. Medical College, Jaipur, Rajasthan, 302004, India,

Acute respiratory distress is one of the most common reason for emergency visits in children under 5 y of age. An accurate understanding of the epidemiology of these diseases, identification of risk factors and etiology is critical for successful treatment and prevention of related mortality. The cause of acute respiratory distress varies in etiology, and hence is amenable to different treatment modalities. Read More

Ear Nose Throat J 2014 Apr-May;93(4-5):154, 156

Department of Otolaryngology/Head and Neck Surgery, Division of Pediatric Otolaryngology, University of Tennessee, Memphis, TN, USA.

J Laryngol Otol 2014 Mar 20;128(3):292-5. Epub 2014 Feb 20.

Department of Paediatric Surgery, Queen's Medical Centre, Nottingham, UK.

Objectives: To report a case of misdiagnosis of an impacted oesophageal button battery in a child, and to describe the associated risk factors for impaction and the management of such cases.

Case Report: An 18-month-old, otherwise fit and well child with stridulous respiration was initially treated for croup. Medical treatment over the course of three months failed, and appropriate imaging subsequently demonstrated an impacted button battery in the upper oesophagus. Read More

Med Gas Res 2013 Aug 4;3(1):18. Epub 2013 Aug 4.

Departments of Neurosurgery and Physiology, Loma Linda University, Loma Linda California, USA.

The noble gas helium has many applications owing to its distinct physical and chemical characteristics, namely: its low density, low solubility, and high thermal conductivity. Chiefly, the abundance of studies in medicine relating to helium are concentrated in its possibility of being used as an adjunct therapy in a number of respiratory ailments such as asthma exacerbation, COPD, ARDS, croup, and bronchiolitis. Helium gas, once believed to be biologically inert, has been recently shown to be beneficial in protecting the myocardium from ischemia by various mechanisms. Read More

Pediatrics 2013 Aug 22;132(2):245-52. Epub 2013 Jul 22.

Department of Pediatrics, Children’s Mercy Hospitals and Clinics, University of Missouri–Kansas City, School of Medicine, Kansas City, Missouri 64108, USA.

Objectives: The objectives were (1) to determine trends in radiograph use in emergency department (ED) care of children with asthma, bronchiolitis, and croup; and (2) to examine the association of patient and hospital factors with variation in radiograph use.

Methods: A retrospective, cross-sectional study of National Hospital Ambulatory Medical Care Survey data between 1995 and 2009 on radiograph use at ED visits in children aged 2 to 18 years with asthma, aged 3 months to 1 year with bronchiolitis, and aged 3 months to 6 years with croup. Odds ratios (ORs) were calculated and adjusted for all factors studied. Read More

J Craniofac Surg 2013 Mar;24(2):380-3

Department of Otolaryngology, Isparta Goverment Hospital, Isparta, Turkey.

Objective: We aimed to evaluate a possible relation between gastroesophageal reflux disease and middle ear effusion in children.

Methods: Children who came to ear, nose, and throat (ENT) department with the symptoms of hearing loss or aural fullness and diagnosed as OME by examination and tympanometry were included into the study. Children were reviewed gastroesophageal reflux disease symptoms including the following: (a) airway symptoms: stridor, frequent cough, recurrent croup, wheezing, nasal congestion, obstructive apnea, hoarseness, and throat clearing; (b) feeding symptoms: frequent emesis, dysphagia, choking: gagging, sore throat, halitosis, food refusal, regurgitation, pyrosis, irritability, failure to thrive, and anemia. Read More

J Emerg Med 2013 Jul 30;45(1):30-3. Epub 2013 Jan 30.

Department of Pediatrics, Westchester Medical Center, New York Medical College, Valhalla, New York 10595, USA.

Background: Foreign body ingestion is a frequent complaint in the Pediatric Emergency Department.

Objective: Button-battery ingestion is discussed, with particular attention being given to its management.

Case Report: Here is an interesting case of a button-battery ingestion by a 1-year-old boy with known asthma who presented to our Emergency Department. Read More

CJEM 2013 Jan;15(1):8-17

Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON, Canada.

Objectives: The objective of this study was to investigate whether different staffing models are associated with variation in radiograph use for children seen for bronchiolitis, croup, and asthma and discharged home from emergency departments (EDs) in Ontario.

Methods: We surveyed all Ontario EDs regarding physician staffing models and use of clinical protocols. We used a population-based ED database to determine radiograph rates and patient characteristics. Read More

Eur J Pediatr 2013 Jul 8;172(7):991-3. Epub 2012 Dec 8.

Service de Réanimation Chirurgicale Pédiatrique, Hôpital Necker Enfants-Malades, Assistance Publique- Hôpitaux de Paris, Faculté de Médecine, Université Paris-Descartes, 149, Rue de Sèvres, 75743 Paris Cedex 15, France.

Unlabelled: Button battery ingestion in children is not a rare occurrence and may be unwitnessed and can be soon life-threatening or responsible for severe sequelae. We report herein an original history of previously healthy 16-month-old boy with an unwitnessed and misdiagnosis of lithium cell coin battery ingestion which leads to bilateral vocal palsy. The patient underwent a unilateral posterior cordotomy and was successfully extubated. Read More

Pediatr Emerg Care 2012 Dec;28(12):1321-7

Division of Ambulatory Pediatrics, University of Istanbul, Istanbul, Turkey.

Objectives: The objective of this study was to determine the evidence-based performance of the pediatric emergency unit in the diagnosis of and treatment approach to the patients with asthma, bronchiolitis, and croup.

Methods: In this study conducted in a retrospective cross-sectional way, emergency cards and computer data have been used. In the performance evaluation, the National Hospital Ambulatory Medical Care Survey criteria were considered. Read More

N Engl J Med 2012 Jul;367(1):66

Mackay Memorial Hospital, Taipei, Taiwan.

Int J Pediatr Otorhinolaryngol 2012 May 24;76 Suppl 1:S84-91. Epub 2012 Feb 24.

Hospital de Pediatría Juan P Garrahan, Buenos Aires, Argentina.

Background: Ingestion and/or aspiration of foreign bodies (FB) are avoidable incidents. Children between 1 and 3 years are common victims for many reasons: exploration of the environment through the mouth, lack of molars which decreases their ability to properly chew food, lack of cognitive capacity to distinguish between edible and inedible objects, and tendency to distraction and to perform other activities, like playing, whilst eating. Most FBs are expelled spontaneously, but a significant percentage impacts the upper aerodigestive tract. Read More

Emerg Radiol 2012 Jun 15;19(3):255-60. Epub 2012 Feb 15.

ENT Department, North West London Hospitals NHS Trust, Middlesex, UK.

A lateral soft tissue neck radiograph is a useful adjunct in diagnosing and managing the patient presenting with upper airway symptoms but is often inadequately reviewed. We present some common findings and robust systems to improve analysis of these radiographs. Read More

J Emerg Med 2012 Nov 13;43(5):e333-4. Epub 2011 Jul 13.

Department of Pulmonary and Critical Care Medicine, National Taiwan University Hospital, Yunlin, Taiwan.

Kaohsiung J Med Sci 2010 Oct;26(10):567-70

Division of Pediatric Cardiology and Pulmonology, Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.

Postobstructive pulmonary edema is life-threatening, and results from a sudden episode of upper airway obstruction. Croup is generally thought to be a benign condition, but occasionally it can develop into postobstructive pulmonary edema. We present a case of a 5-year-old boy with recurrent croup, who was diagnosed with postobstructive pulmonary edema. Read More

Pediatr Emerg Care 2010 Mar;26(3):218-9

Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.

An 11-month-old child presented with what initially appeared to be 2 simple problems, a small elbow effusion followed 1 week later by croup. This case history is presented to remind emergency medicine physicians of the importance of index of suspicion and recognition of the difference between common events occurring in a normal host versus common events occurring in an abnormal host. Read More

Pediatr Radiol 2010 May 18;40(5):781. Epub 2009 Sep 18.

Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.

Eur J Emerg Med 2009 Apr;16(2):109-10

Department of Emergency Medicine, National University Hospital, Singapore.

We report a 54-year-old lady who presented to the emergency department for stridor and shortness of breath of acute onset. Nasopharyngoscopy revealed subglottic swelling and plain radiographs revealed a classical 'steeple sign' typical of croup. Although rare, croup should be considered in an adult presenting with stridor to the emergency department and the emergency airway team should be notified in advance for possible surgical airway emergency tracheostomy. Read More

Eur J Pediatr 2009 Nov 11;168(11):1395-9. Epub 2009 Feb 11.

Paediatric Pulmonology Department, Addenbrooke's Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK.

Introduction: Leukaemia and lymphoma may present with symptoms and signs mimicking common respiratory conditions of childhood such as asthma or croup. The UK National Institute for Clinical Excellence guidelines for referral for suspected cancer state that "the primary healthcare professional should be ready to review the initial diagnosis in patients in whom common symptoms do not resolve as expected" and "must be alert to the possibility of cancer when confronted by unusual symptom patterns" (National Institute for Health and Clinical Excellence, 2005).

Results And Discussion: A child with an undiagnosed mediastinal mass presenting with signs and symptoms suggestive of asthma or croup may be given oral systemic steroids. Read More

Rev Pneumol Clin 2008 Oct 26;64(5):234-7. Epub 2008 Oct 26.

Service de médecine infantile A, hôpital d'enfants, Bab-Saadoun-Jabbary, 1007 Tunis, Tunisie.

Plastic bronchitis (PB) is a rare disease, characterized by the formation of obstructive branching airways tracheobronchial casts. Commonly, PB often complicates the course of cardiac or respiratory disorders. The occurrence of PB before manifestation of the underlying respiratory disease is unusual. Read More

Intern Emerg Med 2008 Dec 4;3(4):387-9. Epub 2008 Mar 4.

J Paediatr Child Health 2006 Mar;42(3):149-50

4th Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, Greece.

We report the case of a 20-month old boy with markedly elevated serum alkaline phosphatase (ALP) levels, documented during an episode of acute laryngotracheobronchitis. Biochemical investigations and imaging studies revealed no evidence of bone or liver disease. Transient hyperphosphatasemia (TH) was confirmed when serum ALP levels normalized within 2 months. Read More

Pediatr Emerg Care 2005 Nov;21(11):801-4

Division of Emergency Medicine, AI duPont Hospital for Children, Wilmington, DE 19899, USA.

Tuberk Toraks 2005 ;53(1):66-9

Department of Chest Diseases, Ankara University, Faculty of Medicine, Ankara, Turkey.

The pathophysiology of upper-airway obstruction (UAO) is complex. Possible causes of UAO that may lead to acute respiratory failure, are as follows: infections like acute epiglottitis and croup, obstructing tumors in the base of the tongue, larynx or hypopharynx, aspirated food or liquid contents, obesity and anatomical variations. Management changes according to the pathogenesis of the disorder. Read More

J Paediatr Child Health 2003 Aug;39(6):477-9

Department of Respiratory Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.

Laryngeal foreign bodies may produce either complete or incomplete airways obstruction. In complete airways obstruction the presentation is with calamitous respiratory difficulty. However incomplete laryngeal obstruction may present with less severe symptoms, resulting in possible misdiagnosis and confusion with other causes of upper airway obstruction such as infectious croup. Read More

Respir Care 2003 Mar;48(3):248-58; discussion 258-60

Division of Pediatric Critical Care Medicine, The Children's Hospital of Buffalo, Buffalo, New York 14222, USA.

Acute obstructive respiratory emergencies in children are a common cause of emergency department visits. The severity of these conditions ranges from mild, self-limited disease to life-threatening forms of rapidly progressive airway obstruction. A high index of suspicion is necessary for prompt diagnosis and treatment. Read More

Radiologe 2002 Mar;42(3):217-21

Children's Hospital Medical Center, 3333 Burnet AV, Cincinnati, OH 45229-3039, USA.

The radiologist should recognize dangerous uncommon conditions such as epiglottitis and membranous croup by their pattern on conventional images. Subglottic narrowing, as from croup, is recognizable on lateral images by loss of the superior interface of trachea and vocal cords. A lateral image is important when an upper esophageal foreign body is seen on a frontal view. Read More

Arch Otolaryngol Head Neck Surg 2001 Apr;127(4):453, 455-6

Madrid, Spain.

Equine Vet J 2001 Jan;33(1):84-90

Department of Large Animal Clinical Sciences, Faculty of Veterinary Medicine, Swedish University of Agricultural Sciences, Uppsala.

The aim of this study was to evaluate potential risk factors associated with hindlimb lameness and radiographic signs of degenerative joint disease (DJD) in the distal tarsus in Icelandic horses. The material consisted of riding horses (n = 420) age 6-12 years sired by 17 selected sires representing all major breeding lines, and of riding horses (n = 194) in the same age range sired by other sires. The examination protocol included the following: interview with owners/trainers, assessment of conformation, motion evaluation and radiographic examination. Read More

Acta Paediatr Taiwan 2000 Jul-Aug;41(4):214-7

Department of Pediatrics, Tri-Service General Hospital, Taipei, Taiwan.

Subglottic hemangioma (SGH) is a benign neoplasm that may cause severe and life-threatening respiratory obstruction in infants. However, patients usually present with inspiratory stridor in the first few months of life and may be mistakenly diagnosed as recurrent or persistent croup. Definitive diagnosis is made by image studies, endoscopic examination and biopsy or all. Read More

Equine Vet J Suppl 1999 Nov(31):26-30

Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands.

The influence of inherent variables (sex, birth weight, final achieved height, monthly weight gain rates and osteochondrosis (OC) status of the parents) on the occurrence of osteochondrotic lesions in the femoropatellar and tarsocrural joints in a group of foals was investigated as part of a research project aimed at the study of the development of osteochondrosis and the influence of exercise on the development of the musculoskeletal system in Warmbloods. The foals were genetically predisposed to develop OC, being offspring of sires that all had radiographically proven OC in either the femoropatellar or the tarsocrural joint. In the mare population the incidence of femoropatellar OC was 16% and of OC in the tarsocrural joint 7%. Read More

Crit Care Clin 2000 Jul;16(3):489-504

Department of Pediatric Critical Care Medicine, Children's Hospital of Philadelphia, Pennsylvania, USA.

Airway management in the pediatric patient requires an understanding and knowledge of the differences and characteristics unique to the child and infant. New and exciting techniques are currently being explored and developed for management of the pediatric airway. Technology in the area of imaging has allowed clinicians to better visualize the airway and aberrations of it. Read More

Radiology 2000 Aug;216(2):428-9

Department of Radiology, Medical College of Virginia of Virginia Commonwealth University, 401 N 12th St, PO Box 980615, Richmond, VA 23298-0615, USA.

Adolesc Med 2000 Jun;11(2):251-62

Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas 77030, USA.

Lower respiratory tract infections are an important cause of morbidity and occasional mortality in adolescents. This article reviews lower respiratory tract infections by anatomic location. Laryngotracheitis, tracheitis, bronchitis, pneumonia, and parapneumonic effusions are discussed. Read More

Ann Otol Rhinol Laryngol 1999 Apr;108(4):378-83

Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, Ohio, USA.

The evaluation of children with airway obstruction always involves a history and physical examination. The definitive diagnosis is most often made with microlaryngoscopy and bronchoscopy (MLB), and in cases of extrinsic compression, information is gained from magnetic resonance imaging. Although plain radiographs of the airway are often used as a primary diagnostic modality in children with airway obstruction, the accuracy of plain radiographs in predicting specific airway abnormalities has not previously been evaluated. Read More

Mayo Clin Proc 1998 Nov;73(11):1102-6; discussion 1107

Pediatric Emergency Service, Mayo Clinic Rochester, Minnesota 55905, USA.

Viral croup, a common illness in children, manifests with noisy, labored breathing. Parainfluenza viruses are the most common cause of croup; however, other causes including epiglottitis and bacterial tracheitis should be considered in the differential diagnosis. The diagnosis is primarily based on clinical findings; imaging studies may be useful in selected cases. Read More

Allergy Asthma Proc 1998 Jan-Feb;19(1):11-3

Department of Pediatrics, West Virginia University School of Medicine, Morgantown 26506-9214, USA.

Upper airway obstruction is well described as a cause of apparent asthma. However, it can be very difficult to diagnose in young children. This 3-year-old male presented with a 1-year history of severe recurrent wheezing with six emergency room visits in the previous 5 months. Read More