Question
A 6 year old presented with difficulty in breathing and drooling.X ray shows the following picture.What can be the most possible diagnosis?
| A. | Fracture of Hyoid Bone |
| B. |
Impacted Wisdom Tooth |
| C. |
Acute Epiglottitis |
| D. |
Acute Laryngotracheobronchitis |
Show Answer
|
Correct Answer � C Explanation |
 |
Ans:C.) Acute Epiglottitis.
Image shows: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.
ACUTE EPIGLOTTITS
- It is an acute inflammation of epiglottis with inflammatory edema of hypopharynx.
- It is a true medical emergency.
- The most common pathogens are those that cause tonsillitis, namely beta-haemolytic Streptococci, with Staphylococcus aureus, Streptococcus pneumoniae, and Haemophilus influenzae also common causes
- Most cases of epiglottitis and meningitis due to H. influenzae are caused by type b organisms that possess a polyribitol phosphate capsule. Otitis media is generally not caused by type b organisms.
CLINICAL FEATURES OF EPIGLOTTITIS
- Onset is sudden
- Symptoms are fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor.
- Patients often sit in sniffing dog position.
- Complications:
- The main complication is death from respiratory arrest due to acute airway obstruction.
- Other complications are rare but include epiglottic abscess, pulmonary edema secondary to relieving airway obstruction and thrombosis of internal jugular vein (Lemierre’s syndrome)
DIAGNOSIS AND TREATMENT OF EPIGLOTTITIS
- Laryngoscopy-“Cherry red” swollen epiglottis is seen.
- Acute Laryngeal Spasm may occur during Indirect Laryngoscopy.
- Radiograph – Culture of blood and secretions covering Epiglottis
- A plain lateral soft tissue radiograph of neck shows the following specific features
- Thickening of the epiglottis—the thumb sign
- Absence of a deep well-defined vallecula—the vallecula sign
- A plain lateral soft tissue radiograph of neck shows the following specific features
- Treatment
- Immediate endotracheal intubation.
- IV antibiotics to cover H.influenzae.
- The antibiotic of choice in acute epiglottitis pending culture sensitivity report is Ampicillin or 3rd generation Cephalosporin like Ceftriaxone.