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.

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.