Related Experiment Video
Updated: Aug 27, 2025
Murine Oropharyngeal Aspiration Model of Ventilator-associated and Hospital-acquired Bacterial Pneumonia
Published on: June 28, 2018
Don't go barking up the wrong tree: Thinking beyond infection in a toddler with stridor
Nichole McCollum1, Dewesh Agrawal1
1Division of Emergency Medicine, Children's National Hospital, 111 Michigan Avenue NW, Washington, DC 20010, United States of America; The George Washington School of Medicine and Health Sciences, 2300 I Street NW, Washington, DC 20052, United States of America.
Insights
A toddler
Area of Science:
- Pediatric Neurology
- Otolaryngology
- Pediatric Pulmonology
Background:
- Persistent stridor and barky cough in toddlers can mimic common pediatric respiratory illnesses.
- Recurrent medical evaluations and treatments for presumed croup or pneumonia may delay diagnosis of underlying conditions.
Observation:
- A toddler presented with a 4-week history of stridor and barky cough, and 1 week of progressive dysphagia.
- Despite multiple medical visits and treatments (antibiotics, steroids), symptoms persisted.
- Initial airway imaging was negative for foreign body, but laryngoscopy revealed bilateral vocal cord paralysis.
Findings:
- Bilateral vocal cord paralysis was identified as the cause of the toddler's respiratory symptoms.
- An intracranial posterior fossa mass was discovered on further imaging, unifying the diagnosis.
Implications:
- Intracranial masses should be considered in the differential diagnosis of persistent stridor and vocal cord dysfunction in children.
- Early identification of neurological causes is crucial for timely intervention and improved outcomes in pediatric respiratory distress.
Abstract:
A toddler presented to the emergency department with persistent stridor and barky cough for 4 weeks and progressive dysphagia for 1 week. During this time, he had sought medical attention 6 additional times and had been treated for pneumonia, wheezing and croup, receiving antibiotics and several courses of steroids without improvement. On the final presentation, airway imaging did not reveal a foreign body. However, bedside laryngoscopy demonstrated bilateral vocal cord paralysis. Further imaging revealed an intracranial posterior fossa mass which provided the unifying diagnosis for his persistent symptoms.
Related Concept Videos
01:30Tonsillitis I: Introduction
Etiology
Three primary contributing factors have been identified.
01:26Tonsillitis II: Management
01:23Chronic Pharyngitis
Etiology
It often arises from persistent viral or bacterial infections affecting sinuses and tonsils.
Additional contributing factors include inadequate dental hygiene, mouth breathing, recurring tonsillitis, allergic rhinitis, laryngopharyngeal reflux, and exposure to smoke, chemicals, and other environmental pollutants. Allergic reactions to pollen, mold, and pet dander, chronic cough, excessive voice usage,...
01:22Trachea
Anatomical Features:
Location: About half of the trachea is situated in the neck, anterior to the esophagus, and extends from the larynx (at the level of...
01:30Acute Pharyngitis
Acute pharyngitis is the inflammation of the back of the throat (pharynx), commonly resulting in a sore throat. It is a frequently encountered condition that prompts individuals to seek medical advice.
Classification
Acute pharyngitis can be categorized based on its underlying cause:
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed....