Case 1017
Croup (steeple sign)What is the diagnosis?
X-ray
1 / 1
Frontal radiograph of the neck (arrow from the original source).
Image: Frank Gaillard, CC BY-SA 3.0 — sourceAnswer hidden. Review the images and history, decide on your diagnosis, then reveal.
Findings
- Tapered narrowing of the subglottic trachea (arrow) — the steeple sign
- Loss of the normal rounded shoulders of the subglottic airway
Case discussion
The steeple sign reflects subglottic oedema in croup. Croup is a clinical diagnosis; radiographs are only needed when the picture is atypical.
The key differential is epiglottitis — a toxic, drooling child with a thumb-shaped epiglottis on the lateral view. Never leave a child with severe stridor unaccompanied in the radiology department.
