Learning Radiology xray montage


General Considerations

  • Acute bacterial epiglottitis
    • Life-threatening, medical emergency due to infection with edema of epiglottis and aryepiglottic folds
  • Organism
    • Introduction of Haemophilus influenzae type B vaccine in 1985 has led to marked decrease in number of cases of epiglottitis
      • Still remains the most common cause
    • Also caused by
      • Pneumococcus
      • Streptococcus group A
      • Viral infection – herpes simplex 1 and parainfluenza
    • May also be caused by thermal injury and angioneurotic edema
  • Age
    • Typically between 3-7 years
    • Peak incidence has become older over last decade and is now closer to 6-7 years
  • Location
    • Purely supraglottic lesion
      • Associated subglottic edema in 25%
    • Associated swelling of aryepiglottic folds causes stridor

Clinical Findings

  • Classical triad is: drooling, dysphagia and distress (respiratory)
  • Abrupt onset of respiratory distress with inspiratory stridor
  • Sore throat
  • Severe dysphagia
  • Older child may have neck extended and appear to be sniffing due to air hunger
  • Resembles croup clinically, but think of epiglottitis if:
    • Child can not breathe unless sitting up
    • “Croup” appears to be worsening
    • Child can not swallow saliva and drools (80%)
  • Cough is unusual

Imaging Findings

  • Patient needs to be accompanied everywhere by a physician experienced in endotracheal intubation
  • Imaging studies are not always necessary for the diagnosis and may be falsely negative in early stages
  • Lateral radiograph should be taken in the erect position only, as
    • Supine position may close off airway
  • Enlargement of epiglottis
    • “Larger than your thumb”
  • Thickening of aryepiglottic folds
    • True cause of stridor
  • Circumferential narrowing of subglottic portion of trachea during inspiration
  • Ballooning of hypopharynx and pyriform sinuses
  • Reversal of the normal lordotic curve of the cervical spine
  • Fiberoptic-assisted, nasotracheal intubation is procedure of choice, so long as airway is secured

Differential Diagnosis

  • Croup
    • Dilatation of the hypopharynx
    • Dilation of the laryngeal ventricle
    • Narrowing of the subglottic trachea
    • Epiglottis is normal
  • Enlarged adenoids 
    • Compression of nasopharyngeal airway
    • Frequently associate with enlargement of the lingual tonsils
    • Epiglottis is normal


  • Secure airway
    • May require intubation or emergency tracheostomy
  • Some use IV steroids
  • Empiric antibiotic therapy


  • Danger of suffocation secondary to complete airway closure
  • Pneumonia

Epiglottitis. A lateral radiograph of the neck using soft tissue technique demonstrates an enlarged epiglottis (red arrow) with markedly thickened aryepiglottic fold (white arrow) diagnostic of acute epiglottitis.
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