"Steeple sign" on X-ray is characteristic of: .jpeg ) - NORCET 9 Mains - 2025

NORCET 9 Mains - 2025

Child Health Nursing (Pediatrics)

Easy

Appeared in: NORCET 9 Mains - 2025

Explanation

The "steeple sign" is a radiological finding on an anteroposterior (AP) neck X-ray.
It represents the tapering and narrowing of the subglottic trachea, the area just below the vocal cords.
This narrowing is caused by significant inflammation and edema, which is the primary pathology of croup (laryngotracheobronchitis).
Croup is most commonly a viral infection affecting young children, typically between 3 months and 5 years of age.

Option A: Epiglottitis is a bacterial infection causing severe inflammation of the epiglottis and surrounding supraglottic structures (above the vocal cords).
Option C: Foreign body aspiration does not cause the symmetric subglottic edema seen in croup. X-ray findings can be normal or may show the object, or secondary signs like unilateral air trapping (hyperinflation) or lung collapse (atelectasis).
Option D: Bronchiolitis is an infection of the lower airways (bronchioles), not the upper airway. Its characteristic findings are seen on a chest X-ray, not a neck X-ray.

Visual 1: Annotated Image - An AP neck X-ray with arrows pointing to the narrowed subglottic trachea, clearly labeling the 'steeple sign'.
Visual 2: Comparative Diagram - A side-by-side illustration showing a normal airway, the subglottic narrowing in croup ('steeple sign'), and the supraglottic swelling in epiglottitis ('thumb sign').
Visual 3: Image - A lateral neck X-ray demonstrating the 'thumb sign' in epiglottitis for comparison.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Radiological signs of pediatric upper airway obstruction as background academic context rather than a clinical decision trigger.
Recognizing the steeple sign is crucial for nurses as it points towards a diagnosis of croup, guiding appropriate respiratory assessment and management, such as administering corticosteroids and nebulized epinephrine.
Differentiating croup from epiglottitis is a critical nursing skill. Epiglottitis is a life-threatening emergency requiring immediate airway intervention, whereas croup is typically managed medically.
A key nursing priority for a child with suspected epiglottitis is to keep them calm and avoid any examination of the throat (e.g., with a tongue depressor), as this can trigger complete airway obstruction.

How to Approach the Question

First, analyze the image provided. Identify the key visual finding, which is the distinct narrowing of the airway below the vocal cords, creating a shape like a church steeple.
Next, read the question stem carefully. It asks which condition is characterized by the "steeple sign" on an X-ray.
Connect the visual finding to your knowledge of pathophysiology. The steeple shape is caused by subglottic (below the glottis/vocal cords) edema.
Evaluate each option based on this specific location of swelling.
Recall that Croup (laryngotracheobronchitis) is defined by inflammation of the larynx, trachea, and bronchi, with the most significant narrowing occurring in the subglottic region.
Eliminate the other options: Epiglottitis involves supraglottic swelling ('thumb sign'), foreign body aspiration causes focal or unilateral findings, and bronchiolitis affects the lower airways.

Concept Tested & Keywords

Concept Tested: Radiological signs of pediatric upper airway obstruction
Stem keywords: Steeple sign, X-ray
Lead-in keywords: characteristic of
Clinical cues: The visual cue of a steeple-shaped narrowing in the trachea is the defining feature.

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