Radiological Category Gastrointestinal Principal Modality CT Principal Modality

Case History: 39 year old female with neck pain, fever and difficulty breathing.

Test Your Diagnosis Which one of the following is your choice for the appropriate

Findings and Differentials Findings: CT demonstrates swelling of the epiglottis and the aryepiglottic folds,

Discussion Epiglottitis is an uncommon disease but has become more common in adults than

References 1. Smith MM, Mukherji SK, Thompson JE, and M Castillo. CT in adult

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Radiological Category: Gastrointestinal Principal Modality: CT Principal Modality: None Case Report #0621 Submitted by: Eduardo J. Gonzalez, M. D. Faculty reviewer: Emma Ferguson, M. D. Date accepted: 13 April 2009

Case History: 39 year old female with neck pain, fever and difficulty breathing.

Radiological Presentations

Test Your Diagnosis Which one of the following is your choice for the appropriate diagnosis? After your selection, go to next page. • Retropharyngeal abscess • Foreign body aspiration • Epiglottitis • Lymph node hypertrophy

Findings and Differentials Findings: CT demonstrates swelling of the epiglottis and the aryepiglottic folds, resulting in stenosis of the subglottic airway. Differentials: • Epiglottitis • Retropharyngeal abscess • Lymph node hypertrophy

Discussion Epiglottitis is an uncommon disease but has become more common in adults than in children due to the Hib vaccine in pediatric patients. Adult epiglottitis is most frequently a disease of men, occurring during the fifth decade of life. It is an acute inflammation involving the epiglottis, vallecula, aryepiglottic folds, and arytenoids. Risk of death is high due to sudden airway obstruction and difficulty intubating patients with extensive swelling of supraglottic structures. The adult mortality rate is around 7%. The pathogens of adult epiglottitis are the same as in child epiglottitis with H. influenzae being the most common. Immunocompromised patients are at higher risk. The presenting acute symptoms include sore throat, odynophagia, dysphagia, muffled voice, and acute respiratory distress. Most adults present in a less acute fashion, and immediate testing is appropriate. Radiographic evaluation for suspected epiglottitis is being replaced by direct visualization of the epiglottis using nasopharyngoscopy as the preferred method of diagnosis. The classic CT imaging presentation is swelling of the epiglottis (thumb sign), aryepiglottic folds and false vocal cords with narrowing of the airway. Supraglottitis has been termed when the infection spreads into prevertebral soft tissues, valleculae, uvula, base of tongue and/or soft palate.

Diagnosis Adult Epiglotittis.

References 1. Smith MM, Mukherji SK, Thompson JE, and M Castillo. CT in adult supraglottitis. AJNR 1996. Aug; 17(7): 1355 -8 2. Schamp S, Pokiese P, Dancer M et al. Radiological findings in acute adult epiglottitis. European Radiology 1999; 9(8): 1629 -31.