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Virtual Pediatric Hospital: Paediapaedia: Epiglottitis Paediapaedia: Chest and Airway Diseases

Epiglottitis

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed


Clinical Presentation:
Seen in an older age group than croup, usually around 3-10 years old. Presents with drooling, fever, signs of systemic toxicity, severe sore throat, rapidly progressive dysphagia, inspiratory stridor, and respiratory distress. Physical exam shows a red, swollen, cherrylike tip of the inflamed epiglottis. Note that both epiglottitis and croup have inspiratory stridor.

Etiology/Pathophysiology:
The most common cause is bacterial infection due to Haemophilus influenza. Other less common causes are angioneurotic edema, thermal injuries from smoke inhalation, caustic ingestion, hemorrhage, and radiation. The enlarged aryepiglottic folds account for much of the airway obstruction

Pathology:
Not applicable

Imaging Findings:
Careful radiographic evaluation is essential. Personnel skilled in the management of pediatric airway obstruction and equipment for emergency intubation must accompany the patient to the radiology department. The lateral film should be done upright with no attempt made to hyperextend the neck which can cause complete airway obstruction.

The lateral film shows a domelike enlargement of the epiglottis with thickened aryepiglottic folds, supraglottic airway narrowing, and obstruction. Twenty-five percent have subglottic airway narrowing. On the CXR lung volumes are normal.

DDX:

References:
See References Chapter.

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