A 32 y. male presents with a feeling that his throat is closing.
He had a soft tissue xray done at an osh.
what do you see?
Our patient had a “thumbprint sign” which is found in epiglottitis. Fortunately, our patient looked well was not drooling, and had no fever. On nasopharyngeal scope he had a cyst of the epiglottis which probably had nothing to do with his symptoms and is not serious.
Epiglottitis, however is serious, and anyone in which there is suspicion of epiglottitis should be scoped with someone at the bedside ready to do a cricothyroidotomy. An illustration is shown below of what the inflamed epiglottis looks like.
picture is C is epiglottitis after antibiotics and recovery.
Epiglottitis is a swelling of the epiglottis causing the three D’s: drooling, dysphagia and distress. Changes in voice,stridor, and increased respiratory rate can also occur. Historically it was caused by H flu, but the use of the Hemophilus vaccine has decreased the rate of epiglottitis by >95%. It used to be a disease of young children but now is a disease of older children and adults. The organisms cultured have also changed with strep species being the most common. In the immunocompromised, Pseudomonas and Candida have been found. Other causes include: inhalation, foreign body ingestion or burns.
FUN FACT: George Washington is thought to have died from epiglottitis.
Our patient was reassured and sent home.
Since the epiglottis is at the base of the tongue, a normal variant of a high rising epiglottis can occasionally be seen in the mouth
Abdallah C. Acute epiglottitis: trends, diagnosis and management. Saudi J Anaesth 2012. Jul- Sept;6(3):279-281 doi 10.4103/1658-354X/0122
Chapurin N. NEJM 2019;381:e15 doi: 10.1056/NEJM;cm/816761
Des Jardine T. (2015) clinical manifestations & assessment of respiratory disease (7ed) Elsevier Health Sciences. P 529 ISBN 798032335872.
Henrique P. 2000 The death of George Washington: He died as he lived Mount Vernon VA: Mt Versnon Ladies Association pp 27-36 ISBN 978-0-931917-35-36.