What's the diagnosis?
This one's a softball, but good to see it to remind yourself what it looks like. For a refresher on what a normal lateral neck film looks like, click here.
Answer in the first comment.
Reference: http://www.nejm.org/doi/full/10.1056/NEJMicm1009990
Reference: http://www.nejm.org/doi/full/10.1056/NEJMicm1009990
This lateral soft-tissue radiograph of the neck shows a “thumb sign”. This radiographic sign is a manifestation of an enlarged and edematous epiglottis, and it suggests a diagnosis of acute infectious epiglottitis.
ReplyDeleteThis was a 58-year-old patient who presented to the emergency department after having had severe throat pain, hoarseness, and fever for 2 days. A physical examination revealed no stridor, respiratory distress, or drooling. The results of an oropharyngeal examination were unremarkable. The diagnosis was made on the basis of the film.
Intravenous antibiotics were administered, and subsequent fiberoptic laryngoscopy confirmed that the epiglottis was swollen and inflamed. An apical epiglottic abscess was also present; it was not drained and was managed medically. Countries with routine pediatric immunization for Haemophilus influenzae serotype b have witnessed a dramatic reduction in the incidence of epiglottitis in children, with the result that the majority of cases of infectious epiglottitis now occur in adults.
The two cases of epiglottitis in adults I've seen (we managed both in the MICU) were from nontypeable Haemophilus influenza (i.e., not serotype b). Both patients were intubated (nasotracheally, as it's exceedingly difficult to intubate conventionally with an inflamed epiglottis) and recovered with antibiotics (Ceftriaxone) and corticosteroids.