A 3-year-old child presents at 2 AM with a 6-hour history of sudden onset inspiratory stridor, barking cough, and hoarseness following a coryzal illness. He is afebrile, alert, and not drooling. On soft tissue lateral neck X-ray, the subglottic region shows a 'steeple sign'. What is the diagnosis?

• A Acute epiglottitis
• B Foreign body aspiration
• C Acute laryngotracheobronchitis (croup) ✓
• D Bacterial tracheitis

Explanation

Acute laryngotracheobronchitis (viral croup) typically affects children aged 6 months to 3 years, presenting at night with barking cough, hoarseness, and inspiratory stridor following an upper respiratory infection. The steeple sign on AP neck X-ray represents subglottic narrowing from mucosal oedema. Epiglottitis causes a 'thumb sign' on lateral X-ray with a toxic, drooling, non-barking child sitting in tripod position. Parainfluenza virus is the most common causative agent for croup.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.