Massive retropharyngeal lymphadenopathy in an infant: an unusual presentation of infectious mononucleosis

Acute Infections That Produce Upper Airway Obstruction

This chapter discusses the common and potentially serious infective causes of acute upper airway obstruction in children. The laryngeal anatomy of young children makes them particularly susceptible to upper airway obstruction, and during acute infections this is exacerbated by inflammation and edema of the airway mucosa. The most common cause of infective upper airway obstruction in children is viral laryngotracheobronchitis, or croup, which is usually a mild and self-limiting illness, but management with corticosteroids may still be necessary. Bacterial causes of upper airway obstruction have fortunately become rare since the introduction of the Haemophilus influenzae B (HiB) immunization, but a few cases of epiglottitis do still occur due to nonimmunization, vaccine failure, and infection with non-HiB organisms. These cases constitute a medical emergency due to the risk of rapid progression to complete airway obstruction. Other rare conditions are discussed including bacterial tracheitis, diphtheria, retropharyngeal, and peritonsillar abscesses. Key learning points in this chapter include the main discriminating factors of the various causes of infective upper airway obstruction, the importance of a calm and minimally distressing approach to the child presenting with stridor, and the need for early anesthetic team involvement in cases with a suspected bacterial etiology or signs of impending airway obstruction.

Upper airway obstruction in infectious mononucleosis

Patients with infectious mononucleosis caused by the Epstein-Barr virus frequently present to the accident and emergency department. The most common presenting symptoms are fever, fatigue, odynophagia and malaise. Although significant airway compromise is rare and occurs in an estimated 1-3.5% of cases, it may present as a potentially life-threatening situation demanding immediate intervention. We present two such cases and discuss their management.