Bronchiolitis physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alonso Alvarado, M.D. [2]Ahmed Elsaiey, MBBCH [3]
Overview
Patients infected with bronchiolitis have toxic appearance and may be cyanotic. Fever is one of the signs of the disease but the lack of it does not exclude the diagnosis. Lung examination shows abnormalities in inspection and auscultation. In inspection, intercostal and substernal retractions can be observed. In auscultation, wheezing and crackles can be clearly heard with decrease in the respiratory sounds. Extrapulmonary manifestations can occur as well like pharyngitis, conjuctivitis, arrythmias, tachycardia and seizures.[1]
Physical Examination
General appearance
- Ill or toxic appearance
- Cyanosis
Vitals
- Fever may or may not be present at the moment of the examination. The lack of fever does not exclude the diagnosis.
Skin
- Cyanosis may be associated with bronchiolitis.
HEENT
In some cases of bronchiolitis the following may be observed:[2]
- Conjuctivitis
- Otitis media
- Pharyngitis
Lung
Rapid changes in respiratory signs are characteristic of bronchiolitis.
Inspection
- Chest retractions:
- Intercostal retractions
- Substernal retractions
- Nasal flaring in infants
Auscultation
- Wheezing
- Rales (crakles)
- Decreasing respiratory sounds may indicate a progression in the airway obstruction which may evolve to respiratory failure.[3]
The association between cyanosis and rales has been shown as a predictor of severity.[4][1]
Heart
In rare cases of bronchiolitis, cardiovascular manifestations may be detected. These signs include:[5][1]
- Atrial tachycardia
- Second degree heart block
- Arrhythmia
Neuromuscular
Neurological manifestations can be also occur in cases of RSV bronchiolitis. These signs include:
- Seizures
- Central apnea
References
- ↑ 1.0 1.1 1.2 Eisenhut M (2006). "Extrapulmonary manifestations of severe respiratory syncytial virus infection--a systematic review". Crit Care. 10 (4): R107. doi:10.1186/cc4984. PMC 1751022. PMID 16859512.
- ↑ Andrade MA, Hoberman A, Glustein J, Paradise JL, Wald ER (1998). "Acute otitis media in children with bronchiolitis". Pediatrics. 101 (4 Pt 1): 617–9. PMID 9521943.
- ↑ Bordley WC, Viswanathan M, King VJ, Sutton SF, Jackman AM, Sterling L; et al. (2004). "Diagnosis and testing in bronchiolitis: a systematic review". Arch Pediatr Adolesc Med. 158 (2): 119–26. doi:10.1001/archpedi.158.2.119. PMID 14757603.
- ↑ Mulholland EK, Olinsky A, Shann FA (1990). "Clinical findings and severity of acute bronchiolitis". Lancet. 335 (8700): 1259–61. PMID 1971330.
- ↑ Donnerstein RL, Berg RA, Shehab Z, Ovadia M (1994). "Complex atrial tachycardias and respiratory syncytial virus infections in infants". J Pediatr. 125 (1): 23–8. PMID 8021780.