Over the years many amazing cases have been presented during the PEMPix presentation at the American Academy of Pediatrics’ annual national Conference and Exhibition during the Section on Emergency Medicine Sessions. PEMPix Classic is a featured series on PEMBlog that will highlight some of those classic cases.
The Case
A 9 month old previously healthy infant presents with three days of intermittent “noisy” breathing with crying or exertion. The infant has associated difficulty swallowing and choking with feeds unless they are upright. There is no fever, congestion or cyanosis. the infant’s vaccines are up to date and there are no sick contacts. An X-Ray of the airway was obtained.
What is the diagnosis?
A. Croup
B. Party balloon in the airway
C. Tracheolaryngomalacia
D. Cervical lung herniation
E. Retropharyngeal abscess
Thanks for sharing this case! I also notice that the prevertebral soft tissue is widened.Can you kindly comment on that. Thanks
Thank you for the feedback. That’s a very good question. I asked a radiology colleague and the prevertebral soft tissue space in this image appears larger than normal because the child’s neck is a bit flexed, the apparent angle of the film, and a little bit due to displacement of tissues by of the herniation of the pulmonary tissue. I don’t have any of the additional imaging, but I do know that this child did not have a retropharyngeal infection or inflammation on a CT scan.