When is a cough not a common cold?
Tommy, age 9 months, came to my office several times for episodes of coughing and wheezing. One November afternoon, he was brought in again for the same complaint, didn’t respond well, and appeared to deteriorate. A plain chest film showed a possible narrowing of the right mainstem bronchus; this was looked at further with an MRI of the chest. The correct diagnosis was then made: Tommy had a cardiovascular abnormality — a bifid aorta with a vascular ring — along with right bronchial stenosis. Cough is a common presenting complaint in the doctor’s office. It can heralda multitude of different conditions, so how do you distinguish them onthe basis of the physical exam?
Search beyond the lungs
Ask about wheezing. Although it’s typical of asthma, young children may experience this symptom with viral infections such as respiratory syncytial virus or bronchiolitis. Once their small airways enlarge, the wheezing resolves. Never fail to consider other causes of first-time wheezing — it could be due to a foreign body, anatomic abnormalities or even cardiac failure. A cough that hurts suggests pleuritis or pericarditis. Painful breathing, or grunting respiration along with tachypnea and fever, raises suspicions of bacterial pneumonia. Frightening for parents to listen to, viral croup presents with stridor in a young child and hoarseness in an older one. Look out for it in the winter months.
Wet or dry
Richard Haber, MD, FAAP, FRCPC is an associate professor of pediatrics at McGill University and the Director of the Pediatric Consultation Centre at the Montreal Children’s Hospital. He is also a community pediatrician.