1/9. Membranous laryngotracheobronchitis (membranous croup).Membranous laryngotracheobronchitis (membranous croup), not previously described as a distinct entity, is characterized by diffuse inflammation of the larynx, trachea, and bronchi with adherent or semiadherent mucopurulent membranes in the subglottic trachea (conus elasticus) and in the upper trachea distal to the conus elasticus. We reviewed 28 cases of membranous croup diagnosed by endoscopy and/or radiographic examination. The importance of the recognition of membranous croup as a distinct entity is discussed. The characteristic radiologic findings consist of subglottic tracheal narrowing, irregularity of contour of the proximal tracheal mucosa, and sometimes detached or partially detached proximal tracheal membranes, which can be mistaken for tracheal foreign bodies.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/9. delayed diagnosis of laryngeal foreign body.Aspiration of a foreign body is a recognized cause of accidental death in children. Paediatricians are aware of the symptoms of inhaled foreign bodies in the lower respiratory tract. However, symptoms which suggest impaction in the larynx do not appear to raise the same index of suspicion of a foreign body. One case of laryngeal foreign body is described with a delay in diagnosis of five days. The clinical presentation, investigations and management are discussed.- - - - - - - - - - ranking = 801.02712948171keywords = respiratory tract, tract (Clic here for more details about this article) |
3/9. Branhamella catarrhalis and croup: toxicity in the upper respiratory tract.Branhamella catarrhalis has gained increasing recognition as a pathogen in the respiratory tract. During the past 18 years, since its transfer from the genus neisseria, it has been associated with infection in cavities of the respiratory tract (sinuses and middle ear). It has been recognized as playing a role in laryngitis. Its isolation in large numbers from the surface and core of acutely and chronically infected tonsils indicates a possible role in these infections. croup (two patients reported here) can now be added to this list. The toxic potential of B catarrhalis, its movement from commensal to pathogen for the upper respiratory tract, and the pathogenic mechanisms by which this has occurred are reviewed.- - - - - - - - - - ranking = 10465.041106409keywords = upper respiratory tract, respiratory tract, tract, upper (Clic here for more details about this article) |
4/9. Subglottic foreign bodies in pediatric patients.Impacted subglottic foreign bodies may produce upper airway obstruction and clinical signs simulating croup or asthma. We identified the roentgenologic and clinical features in six patients. In four of these patients, the parent had not observed the aspiration episode, so that the diagnosis was delayed. Roentgenologic studies demonstrated subglottic narrowing of the upper airway with a homogeneous, poorly defined radiodensity within the narrowed segment. These roentgenologic studies are usually diagnostic; therefore, if infants or young children present with stridor of undetermined cause, soft-tissue upper airway roentgenography is indicated.- - - - - - - - - - ranking = 3keywords = upper (Clic here for more details about this article) |
5/9. Pseudomembranous croup.During a 2-year period, 7 children were seen with a severe form of laryngotracheobronchitis associated with sloughing of the respiratory epithelium and profuse mucopurulent secretions. We have called this condition pseudomembranous croup. The children had severe upper airways obstruction, appeared toxic with high fever, and were older than the typical age group for viral laryngotracheobronchitis. Lateral x-ray films of the airways showed subglottic narrowing and often these suggested the presence of radio-opaque foreign material in the tracheal lumen. At endoscopy, in addition to pseudomembrane in the subglottic region and trachea, there was thick mucopus and debris, and in some cases these changes extended into the bronchi. An artificial airway was required in all except one, and even after intubation it proved difficult to maintain the airway. staphylococcus aureus was the most common pathogen isolated from tracheal cultures but other organisms were grown.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
6/9. Telling patients about medical negligence.A 7-year-old boy, diagnosed as having croup, develops an upper airway obstruction due to epiglottitis during the therapy, resulting in cerebral anoxia. Pediatricians to whom the boy is referred feel that failure to consider epiglottitis in the original diagnosis constitutes negligence. The parents suspect nothing. What should the pediatricians say or do?- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
7/9. herpes simplex virus infection. A rare cause of prolonged croup.Pediatric acute subglottic croup is generally of limited duration (usually 2 to 7 days) and caused by influenza or parainfluenza viruses. Prolonged infections may involve other pathogens. To date and to our knowledge, there has been but a single case report of herpes simplex virus type 1 (HSV-1) infection prolonging croup attributed to prolonged use of corticosteroids. Other authors have reported a wide range of HSV-1 infections of the upper and lower respiratory tracts in all age groups that are usually associated with immunocompromise. Two immunocompetent toddlers with prolonged croup associated with HSV-1-positive subglottic lesions are described herein. In one case the culture was obtained 11 days after just three doses of dexamethasone treatment. In the second case the culture was obtained after 10 days of prednisone therapy; the infection cleared quickly following treatment with acyclovir and rapid taper of the prednisone dose. These cases suggest that prolonged croup-like symptoms warrant thorough airway evaluation. herpes simplex virus type 1 should be a suspected pathogen in cases of prolonged or atypical croup. herpes simplex virus type 1 croup is not necessarily associated with immunocompromise or prolonged corticosteroid therapy. acyclovir seems to be effective in treating other airway HSV infections, and by analogy it is the treatment of choice in recalcitrant herpetic croup. It is unknown whether HSV-1 represents a primary or secondary pathogen in prolonged croup.- - - - - - - - - - ranking = 802.02712948171keywords = respiratory tract, tract, upper (Clic here for more details about this article) |
8/9. pulmonary edema associated with croup and epiglottitis.Two children, ages 9 and 2 1/2 years, with clinical diagnoses of laryngotracheitis (croup) and epiglottis, respectively, developed florid pulmonary edema without evidence of cardiac enlargement. Both children responded to vigorous therapy, which included endotracheal intubation, mechanical ventilation with high oxygen concentrations and positive end expiratory pressure, diuretics, and support of the intravascular volume with colloid infusions. Swan-Ganz catheterization was performed in the child with epiglottitis to elucidate any hemodynamic malfunction. pulmonary artery occluded pressure was found to be normal. We postulate that pulmonary edema may be the result of any of three major physiologic alterations: alveolar hypoxia, increased alveolar-capillary transmural pressure gradient, and a catechol-mediated shift of blood volume from the systemic to the pulmonary circulation. These alterations acting in concert would increase the volume of blood presented to the pulmonary capillaries, the pore size in those capillaries, and the hydrostatic pressure gradient promoting transduation. Failure of pulmonary lymphatics to effectively clear this fluid would result in pulmonary edema. Although pulmonary edema associated with acute upper airway obstruction is unusual, physicians should be altered to its possible appearance and the need for early and vigorous therapeutic measures.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
9/9. adult croup.adult croup is a distinct disease entity that probably represents a heterogeneous clinical syndrome. Three cases of adult laryngotracheitis characterized by upper airway infection and progression to airway obstruction are illustrated. Close observation and prompt decisions regarding airway intervention are critical in effective management, and complete resolution is expected.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |