Bronchiolitis physical examination

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]

Patients infected with bronchiolitis have a toxic appearance and may be cyanotic. Fever is one of the signs of the disease, but a lack of it does not exclude the diagnosis.There may be abnormalities on inspection and auscultation of the chest, for example, intercostal and substernal retractions, wheezing, and crackles. Extrapulmonary manifestations may occur as well, including pharyngitis, conjunctivitis, arrhythmias, tachycardia, and seizures.

• Ill or toxic appearance
• Cyanosis

• Low grade fever
• Tachycardia
• Tachypnea

• Cyanosis

In some cases of bronchiolitis, the following may be observed:^[1]

• Conjunctivitis
• Otitis media
• Pharyngitis

• Rapid changes in respiratory signs that are characteristic of bronchiolitis. These signs include:
  • Inspection
    • Chest retractions:
      • Intercostal retractions
      • Substernal retractions
    • Nasal flaring in infants
  • Auscultation
    • Wheezing
    • Rales (crackles)
    • Decreasing respiratory sounds may indicate a progression in airway obstruction, which may evolve to respiratory failure.^[2]

• The association between cyanosis and rales has been shown as a predictor of severity.^[3][4]

In rare cases of bronchiolitis, cardiovascular manifestations may be detected. These signs include:^[5][4]

• Atrial tachycardia
• Second-degree heart block
• Arrhythmia

Neurological manifestations can also occur in cases of RSV bronchiolitis, including:^[6]

• Seizures
• Central apnea

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