A 27-month-old girl is brought in for evaluation of hoarseness. She was born prematurely, at 27 weeks' gestation, and spent her first 4 months in the neonatal ICU. Earlier discharge summaries and other documents indicate that the stability of her home environment has been a matter of significant concern: her mother has frequently been unable to provide clear or consistent information about the child. Six months earlier, in the middle of winter, the patient was brought to the emergency department (ED) and was subsequently admitted and treated for a presumed asthma exacerbation and bronchiolitis.
You order frontal and lateral views of the patient's airway.
1. On reviewing these radiographs, do you conclude that they are adequate?
2. What do the radiographs show?
A. Early epiglottitis.
B. Esophageal foreign body.
E. Retropharyngeal abscess.
3. What is your next step?
A. Obtain an emergent anesthesia consult.
B. Order an enhanced CT scan of the neck.
C. Repeat the anteroposterior view.
D. Obtain an otolaryngology consult.
(Answers and discussion begin on next page.)
1. Donnelly LF, Jones B, O’Hara SM, et al. Diagnostic Imaging: Pediatrics. Salt Lake City: Amirsys; 2005:127-129.
2. Derkay CS, Wiatrak B. Recurrent respiratory papillomatosis: a review. Laryngoscope. 2008;118:1236-1247.