While viewing a lateral view of a neck radiograph of an 18-month-old child, a therapist notices that the epiglottis is enlarged, the aryepiglottic folds are thickened, and the hypopharynx is overdistended. Which of the following conditions does this child likely have?

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While croup usually improves within a few days of supportive therapy, epiglottitis is a life-threatening disease causing acute inspiratory stridor, fever, and dysphasia (speech impairment). The usual pathogen is Haemophilus influenzae, type B with the risk of infection now greatly reduced by routine immunization programs. The diagnosis should be made by physical examination or by direct visualization through a scope. If a lateral radiograph of the neck is obtained, the epiglottis is enlarged (referred to as the thumb sign) and the aryepiglottic folds are thickened with overdistention of the hypopharynx. The radiograph is performed upright in the position most comfortable for the patient to breathe. Because safety of the child is of primary concern, the radiograph should be performed portably in the emergency department, where intubation can be performed quickly if necessary.

While Viewing a Lateral View of a Neck Radiograph of an 18-Month-Old