University of Perpetual Help System DALTA College of Radiologic Technology

ACUTE LARYNGOTRACHEOBRONCHITIS BY: REYNALDO B. DIAZ I discovered that patient A.T.G. has positive adventitious breath sounds, specifically, stridor. Stridor is a high-pitched wheezing sound resulting from turbulent airflow in the upper airway. It is a physical sign, which is produced by narrowed or an obstructed airway path. According to Seattle Childrens Hospital Research, 2001, stridor is a complication of croup or laryngotracheobronchitis. This may have led the medical team to reach a conclusion, along with all the other signs and symptoms, to diagnose the patient with acute laryngotracheobronchitis. Diagnosis: Croup is diagnosed by auscultation for the telltale barking cough and stridor. History of fever, runny nose, and congestion, and recent upper respiratory tract problems might also help with the diagnosis of the said disease. A. neck X-ray may also be done to rule out any other reasons for the breathing difficulty. An X-ray of a child with croup usually will show the top of the airway narrowing to a point, which doctors call a "steeple sign." Below is the picture of the neck x-ray of patient A.T.G:

Introduction: Acute laryngotracheobronchitis or croup is a subglottic inflammation and edema caused by a viral or bacterial infection of the larynx, trachea, and bronchi. It is the most common cause of upper respiratory tract obstruction in children 6 months to 6 years old. It is accompanied with signs of fever, hoarseness of voice, tachypnea, followed by paroxysms of non-productive brassy cough (Internal Medicine Journal, 2008). Patient History: Patient A.T.G., had fever for 2 days prior to admission to University of Perpetual Help DALTA Medical Center at January 13, 2013, 2:56 P.M. Fever of 37.8 was accompanied by cough with difficulty of breathing, positive vomiting three times, and also with watery bowel movement. Home medication was given. Patient was initially given Paracetamol for the fever but only to vomit the drug. The patient has no history of asthma or any allergy. Causes and Symptoms: Initial symptoms of viral croup are similar to those of a cold. They include sore throat, runny nose, high temperature of 38C (100.4F) or above (in some, but not all, cases), cough. Over one to two days, specific symptoms that are characteristic of croup will develop. These include bark-like cough, hoarse or croaky voice, difficulty breathing, harsh grating sound when breathing in, called stridor, difficulty swallowing. Symptoms of spasmodic croup are similar to those mentioned above. However, a bark-like cough and stridor tend to occur suddenly, usually at night. As the admission of patient A.T.G. progressed, the medical staff members

Lateral view

University of Perpetual Help System DALTA College of Radiologic Technology

Findings: steeple sign compatible with acute laryngotracheobronchitis Conclusion: Croup can be caused by different factors. It can affect anyone but mostly are children. It can be safely managed at home with proper treatment, but complicated symptoms like Increasing or persistent breathing difficulty, fatigue, bluish coloration of the skin, or dehydration indicates the need for medical attention or hospitalization. Viral croup usually goes away in 3 to 7 days. The outlook for bacterial croup is good with prompt treatment. Frequent hand washing and avoiding contact with people who have respiratory infections are the best ways to prevent spreading the viruses that cause croup.

References: Case taken from the University of Perpetual Help DALTA Medical Center Seattle Childrens Hospital Research Internal Medicine Journal http://www.nlm.nih.gov/medlineplus http://www.ncbi.nlm.nih.gov/pubmedh ealth http://kidshealth.org