What is the role of radiography in the workup of epiglottitis?

Updated: Apr 28, 2020
  • Author: Sandra G Gompf, MD, FACP, FIDSA; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Avoid radiography for patients who present in extremis until the airway is secure due to the danger of sudden obstruction.

Radiographs are generally unnecessary when the diagnosis can be made by history and physical examination alone or with nasopharyngoscopy. Only 79% of epiglottis cases are diagnosed using neck soft-tissue radiographs. Bedside ultrasonography is rapid, noninvasive, and accurate in the hands of a practitioner experienced in its use. [20]

Lateral neck soft-tissue radiography

Most adults are not in extremis and may safely undergo imaging. In evaluating stable patients with suspected epiglottitis, lateral neck soft-tissue radiographs are useful screening tools. Perform radiography with portable equipment, if indicated; this may confirm the diagnosis.

The classic lateral neck radiographic findings are a swollen epiglottis (ie, a thumb sign), thickened aryepiglottic folds, and obliteration of the vallecula (vallecula sign). See the image below.

Soft-tissue lateral neck radiograph reveals edema Soft-tissue lateral neck radiograph reveals edema of epiglottis consistent with acute epiglottitis.

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