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Exudative Tracheitis
A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Bacterial tracheitis, membranous or pseudomembranous croup, membranous laryngotracheobronchitis
              • Membranous croup: Confusing term overlapping much more common benign entity of viral croup
          • Definitions

            • Purulent infection of trachea
              • Results in thick, adherent, exudative plaques along tracheal walls
              • Plaques can slough & obstruct airway
            • Controversial disease
              • More frequent in certain medical centers; rarely seen in other centers of similar climate
              • No known cases of death in community without reaching medical center (as would be expected with life-threatening disease)
              • While many cases with significant morbidity/mortality have been confirmed, questions remain concerning overdiagnosis/overtreatment at certain centers

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Gross Pathologic & Surgical Features

                          CLINICAL ISSUES

                          • Presentation

                            • Demographics

                              • Natural History & Prognosis

                                • Treatment

                                  DIAGNOSTIC CHECKLIST

                                  • Consider

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Darras KE et al: Imaging acute airway obstruction in infants and children. Radiographics. 35(7):2064-79, 2015
                                      2. Kuo CY et al: Bacterial tracheitis. Pediatr Rev. 35(11):497-9, 2014
                                      3. Miranda AD et al: Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 27(10):950-3, 2011
                                      4. Sammer M et al: Membranous croup (exudative tracheitis or membranous laryngotracheobronchitis). Pediatr Radiol. 40(5):781, 2010
                                      5. Shargorodsky J et al: Bacterial tracheitis: a therapeutic approach. Laryngoscope. 120(12):2498-501, 2010
                                      6. Huang YL et al: Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. 51(1):110-3, 2009
                                      7. Lee JK et al: Treatment of exudative tracheitis with acute airway obstruction under jet ventilation. Otolaryngol Head Neck Surg. 139(4):606-7, 2008
                                      8. Salamone FN et al: Bacterial tracheitis reexamined: is there a less severe manifestation? Otolaryngol Head Neck Surg. 131(6):871-6, 2004
                                      9. Rotta AT et al: Respiratory emergencies in children. Respir Care. 48(3):248-58; discussion 258-60, 2003
                                      10. Stroud RH et al: An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol. 22(4):268-75, 2001
                                      11. Damm M et al: Management of acute inflammatory childhood stridor. Otolaryngol Head Neck Surg. 121(5):633-8, 1999
                                      12. Bernstein T et al: Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. 27(3):458-62, 1998
                                      13. Brody AS et al: Membranous tracheitis: how accurate is the plain film diagnosis? Pediatr Radiol (Abstr). 27:705, 1997
                                      14. Brook I: Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care. 13(1):16-8, 1997
                                      15. Britto J et al: Systemic complications associated with bacterial tracheitis. Arch Dis Child. 74(3):249-50, 1996
                                      16. John SD et al: Stridor and upper airway obstruction in infants and children. Radiographics. 12(4):625-43; discussion 644, 1992
                                      17. Han BK et al: Membranous laryngotracheobronchitis (membranous croup). AJR Am J Roentgenol. 133(1):53-8, 1979
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              TERMINOLOGY

                                              • Synonyms

                                                • Bacterial tracheitis, membranous or pseudomembranous croup, membranous laryngotracheobronchitis
                                                  • Membranous croup: Confusing term overlapping much more common benign entity of viral croup
                                              • Definitions

                                                • Purulent infection of trachea
                                                  • Results in thick, adherent, exudative plaques along tracheal walls
                                                  • Plaques can slough & obstruct airway
                                                • Controversial disease
                                                  • More frequent in certain medical centers; rarely seen in other centers of similar climate
                                                  • No known cases of death in community without reaching medical center (as would be expected with life-threatening disease)
                                                  • While many cases with significant morbidity/mortality have been confirmed, questions remain concerning overdiagnosis/overtreatment at certain centers

                                              IMAGING

                                              • General Features

                                                • Radiographic Findings

                                                  • CT Findings

                                                    • MR Findings

                                                      • Imaging Recommendations

                                                        DIFFERENTIAL DIAGNOSIS

                                                          PATHOLOGY

                                                          • General Features

                                                            • Gross Pathologic & Surgical Features

                                                              CLINICAL ISSUES

                                                              • Presentation

                                                                • Demographics

                                                                  • Natural History & Prognosis

                                                                    • Treatment

                                                                      DIAGNOSTIC CHECKLIST

                                                                      • Consider

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Darras KE et al: Imaging acute airway obstruction in infants and children. Radiographics. 35(7):2064-79, 2015
                                                                          2. Kuo CY et al: Bacterial tracheitis. Pediatr Rev. 35(11):497-9, 2014
                                                                          3. Miranda AD et al: Bacterial tracheitis: a varied entity. Pediatr Emerg Care. 27(10):950-3, 2011
                                                                          4. Sammer M et al: Membranous croup (exudative tracheitis or membranous laryngotracheobronchitis). Pediatr Radiol. 40(5):781, 2010
                                                                          5. Shargorodsky J et al: Bacterial tracheitis: a therapeutic approach. Laryngoscope. 120(12):2498-501, 2010
                                                                          6. Huang YL et al: Bacterial tracheitis in pediatrics: 12 year experience at a medical center in Taiwan. Pediatr Int. 51(1):110-3, 2009
                                                                          7. Lee JK et al: Treatment of exudative tracheitis with acute airway obstruction under jet ventilation. Otolaryngol Head Neck Surg. 139(4):606-7, 2008
                                                                          8. Salamone FN et al: Bacterial tracheitis reexamined: is there a less severe manifestation? Otolaryngol Head Neck Surg. 131(6):871-6, 2004
                                                                          9. Rotta AT et al: Respiratory emergencies in children. Respir Care. 48(3):248-58; discussion 258-60, 2003
                                                                          10. Stroud RH et al: An update on inflammatory disorders of the pediatric airway: epiglottitis, croup, and tracheitis. Am J Otolaryngol. 22(4):268-75, 2001
                                                                          11. Damm M et al: Management of acute inflammatory childhood stridor. Otolaryngol Head Neck Surg. 121(5):633-8, 1999
                                                                          12. Bernstein T et al: Is bacterial tracheitis changing? A 14-month experience in a pediatric intensive care unit. Clin Infect Dis. 27(3):458-62, 1998
                                                                          13. Brody AS et al: Membranous tracheitis: how accurate is the plain film diagnosis? Pediatr Radiol (Abstr). 27:705, 1997
                                                                          14. Brook I: Aerobic and anaerobic microbiology of bacterial tracheitis in children. Pediatr Emerg Care. 13(1):16-8, 1997
                                                                          15. Britto J et al: Systemic complications associated with bacterial tracheitis. Arch Dis Child. 74(3):249-50, 1996
                                                                          16. John SD et al: Stridor and upper airway obstruction in infants and children. Radiographics. 12(4):625-43; discussion 644, 1992
                                                                          17. Han BK et al: Membranous laryngotracheobronchitis (membranous croup). AJR Am J Roentgenol. 133(1):53-8, 1979