R. NICKBRYANMDPATRICIA A.HUDGINSMD
A healthy 2-year-old boy presented to the emergency department on 5 separate occasions, over a period of 5 months, with difficulty breathing. Each time, clinical examination revealed signs and symptoms of respiratory distress with inspiratory stridor. There was no evidence of neck swelling, oral cavity masses, or enlarged tonsils. Flexible nasopharyngolaryngoscopy revealed small adenoids. The base of tongue, epiglottis, vallecula, and vocal cords were normal, as was vocal cord motion. Pulse oximetry demonstrated oxygen saturations above 94% on supplemental oxygen. The patient was treated with 2 mg of intravenous dexamethasone and nebulized epinephrine. The clinical impression was that of recurrent acute laryngotracheobronchitis. A plain lateral neck radiograph was obtained (Figure 1).
Pang KP, Tan KKH, Tan HM. Radiology Quiz Case 1. Arch Otolaryngol Head Neck Surg. 2004;130(8):996. doi:10.1001/archotol.130.8.996