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©2013 UpToDate ® Print Email Differential diagnosis of bacterial tracheitis Condition Characteristic features Radiographic features Bacterial tracheitis Fever; toxic appearance Intraluminal membranes and tracheal wall irregularity Epiglottitis Fever, toxic appearance; anxiety out of proportion to degree of respiratory distress; "tripod" and/or "sniffing" posture; drooling Swollen epiglottis ("thumb sign") on lateral neck radiograph Laryngotracheitis (croup) Typically occurs in children 6 to 36 months; "barking" cough, stridor; "steeple sign" on anteroposterior neck radiograph Tapering of upper airway ("steeple sign") on anteroposterior neck radiograph Subglottic narrowing and distended hypopharynx on lateral neck radiograph Peritonsillar abscess Typically occurs in older children and adolescents; drooling; trismus; muffled voice; tonsillar swelling with deviation of the uvula Radiographs usually not necessary for diagnosis Retropharyngeal abscess Typically occurs in children aged two to four years; neck pain, fever, pain with swallowing; drooling; unwillingness to move the neck; trismus; midline or unilateral swelling of posterior pharyngeal wall Widening of the retropharyngeal space and reversal of the normal cervical spine curvature Severe bacterial pneumonia Signs of lower respiratory tract infection (eg, crackles, consolidation) Pulmonary infiltrate with or without parapneumonic effusion Foreign-body aspiration History of sudden onset of choking (though this history is frequently absent); hoarseness or stridor with laryngeal or upper-esophageal foreign body Visualization of radio-opaque foreign body; upper-esophageal foreign body may cause distortion or deviation of extrathoracic trachea Diphtheria Sore throat; malaise; low-grade fever; diphtheritic membrane (exceedingly rare in countries with high rates of diphtheria immunization) Radiographs usually not necessary for diagnosis