Croup vs Epiglottitis
How to tell Croup and Epiglottitis apart when a board question makes them look alike.
Step 2 CK pairs are in open beta while clinical review finishes. Spot an issue? Tell us.
Drooling with tripod posture is the quickest bedside separator for epiglottitis.
Side by side
Toddler with barking cough, hoarse voice, inspiratory stridor, and usually low-grade fever from viral subglottic edema.
Child with abrupt high fever, drooling, muffled voice, and tripod posture indicating supraglottic bacterial airway emergency.
Parainfluenza and other respiratory viruses inflame the subglottic trachea causing dynamic upper-airway narrowing.
Bacterial infection of the epiglottis and adjacent tissues causes rapid swelling that can abruptly obstruct the airway.
Neck radiograph may show subglottic narrowing with steeple sign; oxygen saturation is often preserved unless severe obstruction develops.
Lateral neck film may show thumbprint epiglottic swelling; leukocytosis is common and blood cultures may identify bacterial etiology.
The trap
Attempting forceful oropharyngeal examination in a child with suspected epiglottitis can precipitate complete airway obstruction; airway team preparation comes before throat inspection.
The repair move
Next best step: keep the child calm, call anesthesia and ENT for controlled airway securing in the operating room, then start IV ceftriaxone plus vancomycin after airway stabilization.
Try a free question
CoreA 2-year-old child has 2 days of barking cough, hoarseness, and inspiratory stridor that worsens at night. T 38.0 C, oxygen saturation 97%. What is the most likely diagnosis?
Show answer and explanation
Answer: B. Croup. Gradual barking cough with low-grade fever and preserved oxygenation is classic for croup.
Why the other choices are tempting
- A. Incorrect because epiglottitis usually has abrupt high fever, drooling, and toxic appearance.
- C. Incorrect because foreign body aspiration usually has abrupt choking onset without viral prodrome.
- D. Incorrect because bacterial tracheitis often appears more toxic with high fever and purulent secretions.
- E. Incorrect because retropharyngeal abscess usually causes neck stiffness and muffled speech rather than barky cough.
Flashcards
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Which bedside finding most strongly favors epiglottitis over croup in a stridorous child?
Drooling with tripod positioning strongly favors epiglottitis.
What cough quality is typical of croup?
A barking seal-like cough is typical of croup.
Quick answers
What is the fastest way to tell Croup from Epiglottitis?
Drooling with tripod posture is the quickest bedside separator for epiglottitis.
What is the key clue for Croup?
Toddler with barking cough, hoarse voice, inspiratory stridor, and usually low-grade fever from viral subglottic edema.
What is the key clue for Epiglottitis?
Child with abrupt high fever, drooling, muffled voice, and tripod posture indicating supraglottic bacterial airway emergency.
What is the common trap with Croup vs Epiglottitis?
Attempting forceful oropharyngeal examination in a child with suspected epiglottitis can precipitate complete airway obstruction; airway team preparation comes before throat inspection.