3 days of fever, sore throat, dysphagia, and odynophagia. History of uncontrolled diabetes mellitus.
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Markedly enlarged epiglottis with peripheral enhancement, partially obstructing the airway. There is inflammation and swelling of the aryepiglottic folds, obliteration of bilateral piriform sinuses (best seen on coronal images), and mild swelling of the vocal cords. The valleculae are completely obliterated due to severe swelling of the epiglottis.
Multiple lymph nodes of variable size are present, most prominent in level II bilaterally.
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The patient was febrile on presentation to 38.1ºC, with elevated WBC count to 13.8. Flexible laryngoscopy revealed an erythematous and swollen epiglottis. The patient was taken to the OR emergently for awake tracheostomy. The patient improved on IV antibiotics and was discharged with augmentin. Rapid Group A Strep test was negative. Respiratory, throat and AFB cultures demonstrated no growth.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center
- Abdallah C. Acute epiglottitis: Trends, diagnosis and management. Saudi J Anaesth. 2012 Jul-Sep; 6(3): 279–281.
- Nemzek WR, Katzberg RW, Van Slyke MA, et al. A Reappraisal of the Radiologic Findings of Acute Inflammation of the Epiglottis and Supraglottic Structures in Adults. AJNR Am J Neuroradiol 16:495–502, March 1995