Epiglottitis

Acute
epiglottitis; Lateral view in X-ray imaging. The lateral soft-tissue radiograph reveals the "thumb sign" that indicates a swollen epiglottis, suggestive of epiglottitis. The diagnosis was confirmed on subsequent imaging and laryngoscopy. The patient recovered following treatment with predonine and ceftriaxone.
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Preschooler
with stridorLateral radiograph of the airway shows an enlarged epiglottis + thickened aryepiglottic folds.The diagnosis was epiglottitis.
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Preschooler
with a sore throat, fever and drooling. Lateral images of the airway from an airway fluoroscopy exam show a swollen epiglottis (thumb sign) and thickened aryepiglottic folds. The palatine tonsil is also noted to be hypertrophied.The diagnosis was epiglottitis and incidental palatine tonsil hypertrophy.
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Epiglottitis, also known as supraglottitis, is a life-threatening condition caused by inflammation of the epiglottis and aryepiglottic folds ,  which can lead to acute airway obstruction.

Epidemiology

The traditional age of presentation is in children of 3 to 6 years, although this has been changing due to the routine vaccination against Haemophilus influenzae type B (Hib) introduced in most countries. Epiglottitis has had a decreasing incidence since the introduction of Hib vaccinations.

Pathology

Etiology

Hib used to be the most common responsible organism but group A beta-hemolytic Streptococci is becoming more common due to Hib vaccinations .

Causes of epiglottitis include inflammatory and infective, including atypical infections such as TB.

Epiglottitis can be caused by direct extension of infection from other adjacent head and neck regions, such as dental infection, tonsillitis, laryngopyocoele and skin cellulitis .

Inflammatory causes include sarcoidosis. Sarcoidosis associated epiglottitis is usually limited to the supraglottic larynx with sparing of the true vocal cords (as they have a sparse lymphatic system).

Clinical presentation

The presentation has a very rapid course beginning with a sore throat and leading to difficulty swallowing and drooling. However, other presenting symptoms include:

  • fever
  • difficulty speaking
  • muffling or changes in the voice
  • inspiratory stridor
  • severe dysphagia

Acute epiglottitis is potentially life threatening due to the risk of airway obstruction, particularly in children. The adult form tends to have a lower risk of airway obstruction due to the larger size of the adult airway and better tolerance of supraglottic edema .

Radiographic features

Plain radiograph

Lateral soft tissue radiograph of the neck demonstrates thickening of the epiglottis and aryepiglottic folds referred to as the thumb sign.

It should be noted that an omega epiglottis, either a variant of normal or in the setting of laryngomalacia, can result in a similar appearance and can be mistaken for epiglottitis.

In epiglottitis, the hypopharynx may be over-distended.

CT

CT is only rarely obtained, and usually when the diagnosis is unclear. Indeed, placing the child in the supine position can actually precipitate respiratory arrest. If a scan is obtained, marked edema and thickening of the epiglottis and aryepiglottic folds may be seen with narrowing of the airway.

Treatment and prognosis

Treatment must be expeditious given the life-threatening nature of the condition:

  • patients should be kept upright in a comfortable position
  • airway management with oxygen therapy
  • early tracheal intubation by specialist staff: if ET tube placement is impossible because of an inflamed epiglottis, emergency needle cricotracheostomy may need to be performed
  • IV fluids
  • IV steroids and antibiotics

Differential diagnoses

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Epiglottitis:
retropharyngealer
Abszess
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thumb sign of
epiglottitis
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