Clinical Scenario 1 (CS1):
A 2-week-old child presents with respiratory distress. Symptoms appeared in the second week of life, including cyanosis, which worsens with crying and bleeding, accompanied by fever and suspected stridor.
Differential Diagnosis:
- Laryngomalacia
Examination:
- Laryngoscopy reveals a short epiglottis and anterior collapse.
Treatment:
- Observation is often sufficient as laryngomalacia typically resolves on its own. However, severe cases may require surgical intervention.
Management:
- Monitor the child’s growth and respiratory status. Educate parents on positioning and feeding techniques to minimize symptoms.
Indication for Surgery:
- Persistent cyanosis or severe respiratory distress.
Clinical Scenario 2 (CS2):
A 6-month-old presents with stridor that started a few weeks after birth. There is no infection, rhinorrhea, fever, or abnormal cry, and no masses are detected.
Examination:
- Stridor is biphasic.
Differential Diagnosis:
- Subglottic stenosis
- Hemangioma
Diagnosis:
- Confirmed via laryngoscopy.
If Hemangioma:
- Observation is often recommended as many hemangiomas resolve spontaneously.
Epiglottitis:
- This condition is unlikely given the absence of fever and acute distress.
Clinical Scenario 3 (CS3):
A newborn experiences respiratory distress immediately after birth and requires intubation.
Differential Diagnosis:
- Bilateral choanal atresia
- Congenital nasal mass
Investigations:
- Nasal endoscopy and CT scan to evaluate for choanal atresia or nasal masses.
Clinical Scenario 4 (CS4):
A child presents with stridor, respiratory distress, fever, and adopts a sniffing position.
Differential Diagnosis:
- Croup
- Epiglottitis
Investigation:
- X-ray may show a “thumbprint sign” indicative of epiglottitis.
Management:
- For epiglottitis, immediate intubation is crucial.
- Administer dexamethasone for croup to reduce airway inflammation.