The above X-ray shows "Steeple Sign" which is characteristic of Acute Laryngotracheobronchitis/CroupCrouprefers to a heterogeneous group of mainly acute and infectious processes that are characterized by Bark-like or brassy cough that may be associated with hoarseness Inspiratory stridor, and Respiratory distress Stridor is usually inspiratory but can be biphasic MC causative Organism - Parainfluenza virus Croup typically affects the larynx, trachea, and bronchi. Most patients have rhinorrhea, pharyngitis, mild cough, and low-grade fever for 1-3 days before the signs and symptoms of upper airway obstruction become apparent. The child then develops the characteristic barking cough, hoarseness, and inspiratory stridor Symptoms are characteristically worse at night and often recur with decreasing intensity for several days and resolve completely within a week. Croup is a clinical diagnosis and must be distinguished from other diagnoses, including foreign body aspiration, epiglottitis, retropharyngeal abscess, angioedema, and subglottic stenosis or hemangioma. The radiographic steeple sign , consisting of progressive narrowing of the subglottic region of the trachea, is characteristic of croup Croup is a disease of the upper airway, and alveolar gas exchange is usually normal. Hypoxia and low oxygen saturation are seen only when complete airway obstruction is imminent. The child who is hypoxic, cyanotic, pale, or obtunded needs immediate airway management. Rx - Suppoive care , including Oxygen Single dose Dexamethasone (Oral/ IM) - Effective in mild cases Moderate to severe disease needs Suppoive care + Single dose Dexamethasone + Nebilized Epinephrine Antibiotics are not recommended as it is a Viral illness