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General Medicine

Croup (Laryngotracheobronchitis)

Ryan Paul B. Urbi, MD, Olga L. Nunez, MD and Mark T. Nadeau, MD, MBA Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Croup is a subacute viral illness frequently preceded by 24 to 72 hours of symptoms such as nonspecific cough, coryza, rhinorrhea, fever with an abrupt onset of seal-like barking cou...

DIAGNOSIS

  • Croup is a clinical diagnosis; lab tests and imaging serve only ancillary purposes. Most children who present with acute onset of barky cough, inspiratory stridor, hoarseness, and chest wall...

TREATMENT

GENERAL MEASURES

  • Symptomatic treatment

  • Minimize lab tests, imaging, and procedures that upset the child; agitation worsens tachypnea and can be more detrimental than accepting a clinical diagn...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

Most children with croup do not require specific follow-up; should consider PCP follow-up if patient had stridor for >1 week. 

DIET

  • Liquid diet...

REFERENCES

1
Abedi GR, Prill MM, Langley GE, et al. Estimates of parainfluenza virus-associated hospitalizations and cost among children aged less than 5 years in the United States, 1998–2010. J Pediat...

ADDITIONAL READING

Zoorob R, Sidani M, Murray J. Croup: an overview. Am Fam Physician.  2011;83(9):1067–1073. [View Abstract on OvidMedline] 

CODES

ICD10

  • J05.0 Acute obstructive laryngitis [croup]

  • J20.9 Acute bronchitis, unspecified

  • J38.5 Laryngeal spasm

  • J04.2 Acute laryngotracheitis

ICD9

  • 464.4 Croup

  • 466.0 Acute bronchitis

  • 478.75 Laryngeal spasm

  • 464...

CLINICAL PEARLS

  • LT and LTB outbreaks are most common in fall and winter time for population aged 6 months to 3 years. Symptoms often occur at night.

  • Recurrent episodes should be followed up with a sear...

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Related Images
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Figure 266.3. Croup. Steeple sign on a soft-tissue neck radiograph.
Figure 266.3. Croup. Steeple sign on a soft-tissue neck radiograph.
FIG. 11.19. A child with epiglottitis. This 4-year-old girl has epiglottitis caused by Haemophilus influenzae type b. A: She prefers to sit and appears anxious. B: The child assumes the characteristic sniffing position to maximize the patency of her airway.
FIG. 11.19. A child with epiglottitis. This 4-year-old girl has epiglottitis caused by Haemophilus influenzae type b. A: She prefers to sit...
FIG. 11.21. Epiglottitis. A: A swollen, cherry-red epiglottis with an endotracheal tube passing posteriorly. B: In comparison, this child has a thin, pink, uninfected epiglottis.
FIG. 11.21. Epiglottitis. A: A swollen, cherry-red epiglottis with an endotracheal tube passing posteriorly. B: In comparison, this child h...
FIG. 11.23. A: The patient has epiglottitis. The radiograph demonstrates a swollen epiglottis at the level of the hyoid bone, which is convex on both sides and appears in the shape of a thumbprint. Edema anterior to the epiglottis has obliterated the vallecula, which usually appears as an elongated black shadow. Note the marked swelling of the aryepiglottic folds, projecting inferiorly and posteriorly from the epiglottis and the arytenoid cartilages at the base of the folds. Because Haemoph...
FIG. 11.23. A: The patient has epiglottitis. The radiograph demonstrates a swollen epiglottis at the level of the hyoid bone, which is conv...
FIG. 11.24. Epiglottitis. A: A normal epiglottis on a lateral neck radiograph, with the structures illustrated in B. Epiglottitis is similarly depicted radiographically (C, D).
FIG. 11.24. Epiglottitis. A: A normal epiglottis on a lateral neck radiograph, with the structures illustrated in B. Epiglottitis is simila...
FIG. 11.24. Epiglottitis. A: A normal epiglottis on a lateral neck radiograph, with the structures illustrated in B. Epiglottitis is similarly depicted radiographically (C, D).
FIG. 11.24. Epiglottitis. A: A normal epiglottis on a lateral neck radiograph, with the structures illustrated in B. Epiglottitis is simila...
Bronchiolitis due to adenovirus. The wall of this bronchiole shows an intense chronic inflammatory infiltrate, with local extension into the surrounding peribronchial tissue.
Bronchiolitis due to adenovirus. The wall of this bronchiole shows an intense chronic inflammatory infiltrate, with local extension into th...
Fig C 38-1 Croup. (A) Smooth, tapered narrowing (arrow) of the subglottic portion of the trachea (gothic arch sign). (B) A normal trachea with broad shouldering in the subglottic region.
Fig C 38-1 Croup. (A) Smooth, tapered narrowing (arrow) of the subglottic portion of the trachea (gothic arch sign). (B) A normal trachea w...
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