pediatrics
Croup
Diagnosis of Croup
Clinical presentation (eg, barking cough, inspiratory stridor) Anteroposterior (AP) and lateral neck x-rays as needed Diagnosis of croup is usually obvious by the barking nature of the cough. Similar inspiratory stridor can result from Epiglottitis , If the diagnosis is unclear, patients should have AP and lateral x-rays of the neck and chest; subepiglottic narrowing (steeple sign) seen on AP neck x-ray supports the diagnosis. Seriously ill patients, in whom epiglottitis is a concern, should be examined in the operating room by appropriate specialists able to establish an airway ( see Treatment ). Patients should have pulse oximetry, and those with respiratory distress should have arterial blood gas measurement. Epiglottitis, retropharyngeal abscess, and bacterial tracheitis cause a more toxic appearance than croup and are not associated with a brassy, barking cough. 