Epiglottitis in an Adult

New England Journal of Medicine 372(15):e20 (2015) PMID 25853768

A previously healthy 65-year-old woman presented with a 7-day history of throat pain, difficulty swallowing, muffled voice, and fevers. Lateral soft-tissue radiography of the neck showed the “thumb sign,” indicating a swollen epiglottis, suggestive of epiglottitis. A previously healthy 65-year-old woman presented to the emergency department with a 7-day history of throat pain, difficulty swallowing, muffled voice, and subjective fevers. On presentation, she was afebrile and hemodynamically stable with normal oxygen saturation (blood pressure, 140/86 mm Hg; oxygen saturation, 98% while the patient was breathing ambient air). Physical examination revealed mild tenderness and swelling in the anterior neck, without cervical lymphadenopathy or drooling. Lateral soft-tissue radiography of the neck showed the “thumb sign” (Panel A, arrow), indicating a swollen epiglottis, suggestive of epiglottitis. Computed tomography of the neck revealed substantial swelling and edema of the epiglottis . . .

DOI: 10.1056/NEJMicm1400061