Who let the dogs out? Croup

Case presentation

A 14-month-old, previously healthy child presents to the Emergency Department in the middle of the night with respiratory distress, hoarseness, and a barky cough. He has had mild congestion and a low-grade fever for a day. On physical examination, the child is in moderate respiratory distress and is anxious appearing while struggling to inhale each breath. His respiratory rate is 58 breaths per minute, his pulse oxygenation saturation is 98% on room air, and he has prominent subcostal and suprasternal retractions. He is not febrile. On auscultation, he has stridor, but no wheezing or rales in all lung fields, and breath sounds are equal throughout. The child is looking around anxiously without neck movement restrictions or drooling. The parents are concerned that the child “choked on something” since the child’s respiratory distress was so acute in onset. They were seen at an urgent care facility just prior to arrival and had plain chest radiographs performed, which they have provided for review.

Imaging considerations