Differential Diagnosis for Noisy Breathing in a 3-month-old Girl
The patient's symptoms and flexible fiberoptic laryngoscopy results suggest a condition affecting the upper airway. Based on the information provided, the following differential diagnoses can be considered:
- Single most likely diagnosis
- Inspiratory stridor: This is the most likely diagnosis given the patient's symptoms of noisy breathing that worsen when lying on her back and improve when placed on her stomach. The intermittent collapse of the arytenoid cartilages into the airway, as seen on laryngoscopy, is consistent with laryngomalacia, a common cause of inspiratory stridor in infants.
- Other Likely diagnoses
- Biphasic stridor: Although less likely, biphasic stridor (stridor present during both inspiration and expiration) could be considered if the patient's symptoms were not exclusively inspiratory. However, the laryngoscopy findings and clinical presentation point more towards an inspiratory issue.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Epiglottitis: Although rare in this age group and clinical context, epiglottitis is a life-threatening condition that requires prompt recognition and treatment. The patient's lack of symptoms such as fever, drooling, and severe respiratory distress makes this less likely, but it should always be considered in cases of upper airway obstruction.
- Foreign body aspiration: This is another critical diagnosis to consider, especially if there were any suggestive symptoms or history. However, the patient's gradual onset of symptoms and lack of acute respiratory distress make this less probable.
- Rare diagnoses
- Expiratory wheezing: This would be unusual in the context of the patient's symptoms and laryngoscopy findings, which suggest an upper airway issue rather than a lower airway problem like wheezing.
- Expiratory stridor: While stridor can be expiratory, the patient's symptoms and the specific findings on laryngoscopy (collapse of arytenoid cartilages during inspiration) make inspiratory stridor more likely.
- Inspiratory rhonchi: Rhonchi are typically associated with secretions or obstruction in the larger airways and would not fully explain the patient's symptoms or the specific laryngoscopy findings.