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Mycoplasma is  a well known cause of acute laryngotracheitis in older
children. Besides, the common viral (parainfluenza, RSV, influenza...etc)
agents are still the most likely, even at this age. The preceding URI
prodrome for 2 days is clearly consistent with classic infectious "croup".
 
I could speculate on the significant aerophagia. With significant
extra-thoracic obstruction, as this child had, large intrathoracic negative
pressues are apt to be generated. This may have lead to reflux of air from
the stomach into a negatively pressured esophagus.
 
Jay Pershad, MD
 
----- Original Message -----
From: Dr. Nikolaus Lutz-Dettinger <[log in to unmask]>
> we recently saw a five year old child, coming to the emergency
> department just before noon in severe respiratory distress. He had
> never had such problems before; he had a cough for two days with low
> grade fever; a family physician had prescribed beta-mimetic
> inhalation .In the course of the morning he became increasingly
> more dyspnoeic.
> The clinical picture was that of a very severe attack of
> laryngotracheitis. We found a bit atypical: the hour of presentation,
> age at first presentation, clinical severity (the breathing sounds
> were grotesque in relation to the objective respiratory problems). To
> exclude a foreign body, we took X-rays and did a radioscopy; these
> showed a penciltip-sign, but also an unexpected finding, for which I
> would like your opinion: the stomach was filled with air, but not
> very large; however, the left part of the diaphragm stood slightly
> above the right part. The oesophagus was air filled and grossly
> distended.
 
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