5-Minute Clinical Consult : Tracheitis

Tracheitis

Tests

Laryngoscopy or bronchoscopy:
- Direct visualization and suctioning of obstructed airway is both diagnostic and therapeutic.
- Findings include a red, edematous and/or eroded trachea and bronchi with purulent secretions and pseudomembrane.
- Consider in an ill-appearing child with an unclear diagnosis or when the child’s condition does not respond to current management.
Tracheal bacterial culture (for aerobic and anaerobic bacteria): The gold standard for diagnosis
Tracheal Gram stain for pathogens and white blood cells (especially polymorphonuclear leukocytes): Helps differentiate bacterial infection from colonization
Blood culture: Rarely helpful in diagnosis (<50% positive)
CBC: Little diagnostic value, but may show leukocytosis with a left shift
ESR and/or C-reactive protein: May be elevated

Imaging

Radiographs must be completed in controlled settings by personnel who are trained in airway management.
Lateral and anteroposterior neck films: Findings include distention of the hypopharynx, subglottic narrowing, and irregularity of the tracheal wall owing to mucosal sloughing or the presence of a pseudomembrane.
Chest radiograph: Obtain if pneumonia, which may be concurrent, is suspected.

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