He had been admitted the day before with cough and respiratory distress.
He has received atrovent, adrenaline and budesonide nebulisers for wheeze and stridor. At times he looks very distressed with severe recession, inspiratory stridor, wheeze and cyanosis. Other times he looks settled with minimal recession.
Comment on the child’s clinical state?
What specific questions would you ask his parents?
Answer: Biphasic airway noises suggesting tracheal obstruction. Ask about a his a history of previous noisy breathing or intubation
Bronchiolitis does not cause stridor. Of concern also is the episode of cyanosis.
After intubation he was extremely difficult to ventilate.
He had never been intubated previously and although had evidence of chronic sternal recession his parents had been reassured this was normal.
Investigation revealed the cause to be congenital tracheal stenosis and an anomalous left pulmonary artery (‘ring-sling’ anomaly).
CT scan was taken
Comment on this CT scan ?
what is your definitive diagnosis ?
