Epiglottitis

Etiology:
— Classically due to Haemophilus influenzae type b in 2-5 years old
— Now due to Staphylococcus aureus or Streptococcus in 10-11 years old
— Can also be due to thermal injuries from smoke inhalation or caustic ingestion or hemorrhage or radiation or angioedema
— Swollen epiglottis and swollen areyepiglottic folds cause airway obstruction with swollen areyepiglottic folds contributing most of the airway obstruction
Imaging:
— Lateral radiograph shows supraglottic process with swollen and thickened and rounded epiglottis and thickened aryepiglottic folds
— Subglottic trachea normal
— Thumb sign = imprint of swollen epiglottis on airway
DDX:
Complications: Can obstruct airway so need to have someone who can manage obstructed airway with patient at all times
Treatment:
Clinical:
— Symptoms are sore throat, high grade fever, appearing toxic, appearing restless, drooling, head tilted forward to keep airway open, stridor, dysphagia
— Symptoms are less severe in older patients today

Radiology Cases of Epiglottitis

Radiograph of epiglottitis — Lateral radiograph of the airway shows an enlarged epiglottis + thickened aryepiglottic folds.

Radiograph of epiglottitis — Lateral radiograph of the airway shows a swollen epiglottis (thumb sign) and thickened aryepiglottic folds.

Airway fluoroscopy of epigottitis — 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.

Radiograph of epiglottitis — Lateral radiograph of the airway shows a swollen and thickened and rounded epiglottis (thumb sign) and thickened aryepiglottic folds.

Radiology Cases of Epiglottitis After Treatment

Radiograph of epiglottitis — Lateral radiograph of the airway at presentation (left) shows a swollen epiglottis (thumb sign) and thickened aryepiglottic folds. Lateral radiograph of the airway taken after 3 days of antibiotic therapy (right) shows an interval decrease in the amount of swelling of the epiglottis and aryepiglottic folds.

Radiograph of epiglottitis — Lateral radiograph of the airway (left) shows swelling of the epiglottis (thumb sign) and areyepiglottic folds. Followup lateral radiograph of the airway after a week of antibiotic therapy (right) shows a near normal appearance of the epiglottis and areyepiglottic folds.

Clinical Cases of Epiglottitis

Clinical image of epiglottitis — Clinical image shows a toxic appearing child who is drooling whose head is tilted forward to keep airway open.

Endoscopy Cases of Epiglottitis

Endoscopic image of epiglottitis — Endoscopic image shows an enlarged epiglottis and thickened areyepiglottic folds with an endotracheal tube in the trachea.

Endoscopy image of epiglottitis — Endoscopic image shows an enlarged, cherry-red epiglottis in the center of the image and enlarged aryepiglottic folds lateral to it.

Endoscopy image of epiglottitis — Endoscopic image shows an endotracheal tube in the center of the image and enlarged cherry-red aryepiglottic folds lateral to it.

Gross Pathology Cases of Epiglottitis

Gross pathological image of epiglottitis — Gross pathological image shows a swollen epiglottis in the midline of the specimen with thickened aryepiglottic folds visible lateral to it.

Pathology image of epiglottitis — Post-mortem pathological image shows a swollen epiglottis in the center of the specimen and thickened aryepiglottic folds lateral to it.