This is a patient that I saw in the ED a few weeks back. She was a young otherwise health female who presented to the ER for several days of sore throat, pain with swallowing, and difficulty swallowing. On exam her airway was patent and she did not have stridor. She had tenderness over the anterior neck at the level of the hyoid. She felt that she couldn’t swallow because of the pain and was frequently spitting up oral secretions.
Xray above show a ‘thumbprint sign’ of acute epiglottitis (the enlarged soft tissue outline over the hyoid bone). Bedside nasopharyngeal scope showed epiglottitis without evidence of airway obstruction.
Following widespread use of H.Influenza B vaccine pediatric epiglottitiis is a far more rare clinical entity. Remember epiglottitis is also an adult disease process. In addition to HIB, strep and staph species are most commonly found in adult epiglottis. This patient with treated with clindamycin and steroids and did well during observation stay. Our main goal in these patients is to rapidly identify and manage airway obstruction when it exists.
Cool case Sierra! What tipped you off that there was something more than pharyngitis going on, and had you pursue further diagnostics?
She had a bit of a ‘hot potato voice’ and anterior neck tenderness on exam over the hyoid which is was suggestive of epiglotitis, The difficulty handling oral secretions was also a tip off.