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Radiological Case of the Month

Steven M. Gold, MD; Sally R. Shott, MD; Charles M. Myer III, MD
Arch Pediatr Adolesc Med. 1996;150(1):97-98. doi:10.1001/archpedi.1996.02170260101017.
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A 9-YEAR-OLD child presented to the emergency department with a 2-day history of upper respiratory tract symptoms, sore throat, odynophagia, and mild hoarseness. Results of physical examination were significant for mild pharyngeal erythema and a temperature of 38.1°C (100.5°F). A throat culture was obtained and the patient was treated with antibiotic injection. Over the next 6 hours, the patient's breathing became progressively more labored and her temperature rose to 39.4°C (103°F). The patient returned and results of physical examination revealed an ill-appearing child in mild to moderate respiratory distress. The patient was tachypneic with inspiratory stridor, significantly worsened hoarseness, and a nonproductive cough. She lay flat and exhibited substernal retraction and drooling. Her oxygen saturation remained at about 90% while breathing room air. Her white blood cell count was 9.04 × 109 with lymphocytosis. Airway radiographs were obtained (Figure 1 and Figure 2) prior to undertaking a treatment plan.

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