Appreciate the thumbprint sign at the top of the airway. Also appreciate the swollen aryepiglittic folds posterior to the airway column. What is the most common etiology of this disease? Why don’t we see it as commonly as we once did in pediatrics? What is the acute management?
Why is seeing this finding on a radiograph problematic?
Alright I'll give this a shot...please be easy on me
So the thumbprint sign would be an enlarged epiglottis, likely from inflammation.
Most likely etiology: acute epiglottitis due to H. influenza b infection. Could also be from other bacteria, and less likely from viruses. Non-infective causes could be trauma (e.g. hot, caustic, or irritant materials) or from lymphoproliferative disorders, and are uncommon.
Why don't we see it as commonly as we once did in peds? Because we vaccinate against Hib in infants. The vaccine is not 100% effective and not everyone gets it so acute epiglottitis due to Hib infection is still seen.
What is the acute management? Maintain and secure the airway. How depends on how severe obstruction is, but you have to be ready to intubate at any time (so x-ray should likely be a portable with physician at the beside).
Why is seeing this finding on a radiograph problematic? Not sure what you mean exactly by this questions but I will say because things can deteriorate very quickly and the condition is life threatening.
That's my attempt, please correct my errors and fill in my gaps :D
Actually the "less likely from viruses" comment should be edited to read as "essentially always bacterial". And these days, with Hib vaccinations prevalent, the most common pathogen is Staph aureus.
Children with this condition are taken (if possible) to the operating room for intubation, since any minor disturbance of the epiglottis can cause sudden swelling and complete obstruction, requiring immediate surgical airway placement. So management involves securing the airway in a very formal fashion.
And seeing this on x-ray is problematic because the radiograph is not required for diagnosis. This child should be sitting in a tripod position, with the neck extended, drooling, stridorous .... he might as well have a neon sign on his forehead saying "imminent airway collapse". This is a kid who should be triaged clinically to the operating room, for direct inspection and intubation, and tracheotomy if things go badly. Stopping by the x-ray suite just provides an unnecessary delay with accordant risk.
Acute epiglottitis:
ReplyDeleteAppreciate the thumbprint sign at the top of the airway. Also appreciate the swollen aryepiglittic folds posterior to the airway column. What is the most common etiology of this disease? Why don’t we see it as commonly as we once did in pediatrics? What is the acute management?
Why is seeing this finding on a radiograph problematic?
Alright I'll give this a shot...please be easy on me
ReplyDeleteSo the thumbprint sign would be an enlarged epiglottis, likely from inflammation.
Most likely etiology: acute epiglottitis due to H. influenza b infection. Could also be from other bacteria, and less likely from viruses. Non-infective causes could be trauma (e.g. hot, caustic, or irritant materials) or from lymphoproliferative disorders, and are uncommon.
Why don't we see it as commonly as we once did in peds? Because we vaccinate against Hib in infants. The vaccine is not 100% effective and not everyone gets it so acute epiglottitis due to Hib infection is still seen.
What is the acute management? Maintain and secure the airway. How depends on how severe obstruction is, but you have to be ready to intubate at any time (so x-ray should likely be a portable with physician at the beside).
Why is seeing this finding on a radiograph problematic? Not sure what you mean exactly by this questions but I will say because things can deteriorate very quickly and the condition is life threatening.
That's my attempt, please correct my errors and fill in my gaps :D
Actually the "less likely from viruses" comment should be edited to read as "essentially always bacterial". And these days, with Hib vaccinations prevalent, the most common pathogen is Staph aureus.
ReplyDeleteChildren with this condition are taken (if possible) to the operating room for intubation, since any minor disturbance of the epiglottis can cause sudden swelling and complete obstruction, requiring immediate surgical airway placement. So management involves securing the airway in a very formal fashion.
And seeing this on x-ray is problematic because the radiograph is not required for diagnosis. This child should be sitting in a tripod position, with the neck extended, drooling, stridorous .... he might as well have a neon sign on his forehead saying "imminent airway collapse". This is a kid who should be triaged clinically to the operating room, for direct inspection and intubation, and tracheotomy if things go badly. Stopping by the x-ray suite just provides an unnecessary delay with accordant risk.
THANKS for the commen, Asra'a :)