What's the Diagnosis? By Dr. Lauren Murphy

A 53 yo M presents to the ED with 3 days of a severe sore throat and odynophagia. His vital signs are within normal limits. On physical exam, he has no stridor or drooling, but does have a muffled voice. A soft tissue neck xray is obtained. What's the diagnosis? (scroll down for answer)




Answer: Acute Epiglottitis



  • Acute inflammation in the supraglottic region of the oropharynx (epiglottis, vallecula, arytenoids, and aryepiglottic folds)
  • Can occur at any age, but incidence increasing in older patients 
  • The most common causes are beta-hemolytic streptococci, Staphylococcus aureus and Haemophilus influenzae type b (elderly and immunocompromised patients)
  • Key findings on lateral soft tissue xray of the neck include: obliteration of the vallecula, swelling of the aryepiglottic folds, and an enlarged "thumb-print" shaped epiglottis (indicated by arrow above)
  • Patients have high risk of developing airway edema and obstruction and early airway management should be a priority (consider intubation in OR setting w/ anesthesia, ENT present)
  • Initiate treatment promptly with IV steroids and antibiotics