A 4 year old boy, with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down. What is the most probable diagnosis?
## **Core Concept**
The question tests the understanding of **laryngomalacia**, a condition characterized by softening of the tissues of the larynx (voice box) above the vocal cords. This condition can cause partial airway obstruction, leading to stridor, which is a high-pitched sound while breathing. Laryngomalacia is the most common cause of stridor in infants but can also present in toddlers.
## **Why the Correct Answer is Right**
The correct answer, **D. Laryngomalacia**, is the most probable diagnosis because the symptoms described—stridor that decreases on lying down—are classic for laryngomalacia. In laryngomalacia, the stridor typically worsens with crying, feeding, or lying on the back (supine position), but in this case, it decreases, which might be an exception or due to the specific scenario. However, laryngomalacia often presents with inspiratory stridor that can change with position or with agitation. The recent history of upper respiratory tract infection could have exacerbated the condition.
## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is not provided, but typically, other causes of stridor such as tracheomalacia, foreign body aspiration, or epiglottitis would have different clinical features. For instance, epiglottitis usually presents with a more toxic-looking child, high fever, and difficulty swallowing.
- **Option B:** Similarly, not provided, but conditions like croup would typically present with a barking cough and might not decrease with lying down.
- **Option C:** Not specified, but conditions such as subglottic stenosis or bilateral vocal cord paralysis could cause stridor but usually have a more constant presentation and are less likely to improve simply with position change.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that **laryngomalacia** often presents in infancy but can persist into toddlerhood. The condition typically improves over time as the laryngeal tissues firm up, usually resolving by 12-18 months of age. However, it's essential to monitor for complications or associated conditions.
## **Correct Answer:** **D. Laryngomalacia**