Don't go barking up the wrong tree: Thinking beyond infection in a toddler with stridor

Nichole McCollum; Dewesh Agrawal

doi:10.1016/j.ajem.2022.09.016

Don't go barking up the wrong tree: Thinking beyond infection in a toddler with stridor

Am J Emerg Med. 2022 Dec:62:149.e1-149.e4. doi: 10.1016/j.ajem.2022.09.016. Epub 2022 Sep 19.

Authors

Nichole McCollum¹, Dewesh Agrawal²

Affiliations

¹ Division 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. Electronic address: nmccollum@childrensnational.org.
² Division 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.

PMID: 36182581
DOI: 10.1016/j.ajem.2022.09.016

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.

Keywords: Croup; Pediatric emergency medicine; Stridor; Vocal cord paralysis.

Publication types

Case Reports

MeSH terms

Child, Preschool
Croup*
Foreign Bodies*
Humans
Laryngoscopy
Male
Respiratory Sounds / etiology
Vocal Cord Paralysis* / diagnosis
Vocal Cord Paralysis* / etiology