History of Present Illness:
A teenager is brought to the ER by parents for 2-3 months of progressive shortness of breath since he was admitted to the ICU after a bad MVA. At that time he had multiple rib fractures a pneumothorax and a splenic laceration. His mom says his breathing is “noisy” at times, especially when he exerts himself or is talking a lot.
Vital Signs & Physical Exam:
Vital signs and pulse ox were normal. There was very subtle stridor while talking. Oral and pulmonary exams are otherwise unremarkable
Initial Diagnostic Testing:
- Basic labs all normal
- CXR showed healed rib fractures and no PTX or HTX
- Neck X-ray below
What is the most accurate diagnosis?
- A) Epiglottitis
- B) Croup
- C) Tracheitis
- D) Hyoid fracture
- E) None of the above
SCROLL DOWN FOR ANSWERS & 1-MINUTE CONSULT
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ANSWER:
- A) Epiglottitis
- B) Croup
- C) Tracheitis
- D) Hyoid fracture
- E) None of the above – CORRECT – he has subglottic stenosis, a rare complication of prolonged intubation.
1-Minute Consult on this topic:
- Clinical: SOB + stridor ? presenting indolently weeks after a prolonged intubation, esp in kids
- Location: occurs at the level of the cricoid cartilage
- Causes: Burns, radiation, infections, GERD, autoimmune, amyloidosis, SLE, RA, congenital…
- Treatment: Observation, carbon laser ablation, reconstructive surgery
NIH Stat Pearls on Subglottic Stenosis: Click HERE