Thursday, June 19, 2008

8 - Thumb print sign

Q.3."thumb print " sign seen in ?
a.acute epiglottitis
b.acute sinusitis
c.acute laryngitis

ans is a.acute epiglottitis . ( it is also seen in ischemic colitis )

The term acute epiglottitis is used to describe a condition in which there is inflammation of the epiglottis and commonly the soft tissues surrounding the epiglottis. The condition is rare, but can be life threatening as inflammation of the epiglottis and surrounding tissues may lead to the complete obstruction of the upper respiratory tract.

Haemophilus influenzae type B (most common)
Group A beta-haemolytic Streptococcus
Mycobacterium tuberculosis
Local trauma e.g. following inhalation of foreign bodies or post intubation
Acute epiglottitis is most common in children between the age of 2 and 8, although it can occur at any age
Males are more commonly affected than females with a ratio of 2.5:11
In adults, smoking and reduced levels of immunity appears to be risk factors, and there is some evidence to suggest an increased risk in diabetics2
Since the advent of vaccination against Haemophilus influenzae type b in children, the incidence of acute epiglottitis in children has reduced
Over the last few years the presence of epiglottitis in adults is being increasingly seen3,1
Many of the signs and symptoms associated with acute epiglottitis are common, and may occur in many less serious disorders. Patients with epiglottitis may present with any of the following, and the symptoms may evolve very quickly over a period of a few hours.4

Commonest symptoms
Sore throat
Muffled voice
Anterior neck tenderness
Other features
Ear pain
Cervical lymphadenopathy
The " rxpg sign" - patient leans forward on outstretched arms to move inflamed structures forward thereby easing the upper airway obstruction2
With more severe epiglottitis
Stridor (late finding-indicates airway obstruction)
Respiratory distress

Patients who are suspected of having acute epiglottitis should not have their throat examined with the aid of a tongue depressor, due to the risk of laryngeal obstruction, but should be urgently referred for laryngoscopy.

Fibreoptic laryngoscopy remains the "gold standard" for diagnosing epiglottitis as the epiglottis can be seen directly. Laryngoscopy in these patients should only be performed in areas such as operating theatres which are prepared for intubation or tracheostomy in the event of upper airway obstruction.
Lateral neck X ray may be useful if laryngoscopy is not possible. Soft-tissue radiograph of the neck may show the "thumbprint sign".5
Throat swabs may be taken when the airway is secure, or when intubation/tracheostomy facilities are at hand. Streptococci are becoming the major pathogens in acute epiglottitis now.6
Blood cultures may be taken if the patient is systemically unwell.
CT or MRI scans may be performed if abscess formation is suspected.

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