Paediatric Imaging

Croup

(also called laryngotracheobronchitis), viral disease, most commonly caused by the para influenza viruses, but also by respiratory syncytial virus and rhino virus. There is inflammation of the vocal cords and trachea with tracheal and bronchial wall oedema, causing narrowing and obstruction to airflow. Maximal narrowing is in the subglottic region. This may be seen on both an AP and lateral airway view. There is loss of the normal shouldering of the airway in the subglottic region as seen on the AP chest view (Fig.1), and sometimes associated ballooning of the hypopharynx. The narrowing is better demonstrated on edge-enhanced digital radiographs than on conventional films with intensifying screen. The diagnosis is clinical and there is no need for confirmatory radiographs but the chest radiograph is often requested to assess coexistent lung infection, seen as increased bronchovascular markings within the lungs. Clinically, the child presents with a history of stridor and symptoms of respiratory tract infection.

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Fig.1

Detail from a chest radiograph of a child with croup. Note the narrowed irregular subglottic trachea, typical of croup.
Croup, Fig.1