Pediatric Radiology > Chest > Pediatric Airway > Acute epiglottitis

Pediatric Airway

Acute epiglottitis

Acute epiglottitis is seen less commonly now that children are immunized against Haemophilus influenzae type b. However, the clinical presentation can be striking.

  • The child will have a high fever, dysphagia and sore throat.
  • The child will be sitting upright with head held forward in severe respiratory distress.

  • Intubation may be necessary to maintain the airway, so it is best not to take the patient out of the emergency department for imaging. If imaging is obtained, a lateral soft tissue neck film should be taken in an upright position. The hypopharynx will be enlarged with thickening of the epiglottis and aryepiglottic folds. The thickening of the epiglottis results in the "thumb sign". Subglottic edema, as seen in croup, will also be found in 25% of patients with epiglottitis.


    Lateral soft tissue demonstrates thickening of aryepiglottic folds and the epiglottis ("thumb sign"). Also note the enlargement of the palatine tonsil.


    © Copyright Rector and Visitors of the University of Virginia 2021