A 10-month-old boy presents with his fourth episode of inspiratory stridor and barking cough, each resolving with nebulised adrenaline. He was born at term with no intubation history. Flexible endoscopy shows normal supraglottis and mobile cords, but direct laryngoscopy reveals circumferential narrowing just below the vocal cords with a normal cry between episodes. The most likely diagnosis is:

• A Acquired post-intubation subglottic stenosis
• B Recurrent respiratory papillomatosis
• C Subglottic haemangioma
• D Congenital subglottic stenosis ✓

Explanation

Congenital subglottic stenosis is defined as failure of recanalisation of the receding laryngeal lumen, giving circumferential narrowing below the cords without prior intubation. It classically mimics recurrent croup, with repeated episodes responding to adrenaline. Acquired stenosis requires a preceding intubation history, subglottic haemangioma typically shows a compressible vascular lesion often with cutaneous haemangiomas, and papillomatosis produces warty lesions on the cords themselves with voice change.

Reference: Cummings Otolaryngology: Head and Neck Surgery, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.