A reappraisal of the radiologic findings of acute inflammation of the epiglottis and supraglottic structures in adults.
OBJECTIVE
To evaluate the radiologic characteristic of acute inflammation of the epiglottis and supraglottic structures in adults.


METHODS
The clinical and radiographic findings in 27 adult patients with epiglottitis (average age, 43 years; range, 28 to 81 years) were compared with those of a control group of asymptomatic subjects (n = 15; average age, 48 years; range, 24 to 79 years). Unusual clinical aspects in the current series included two patients who were positive for human immunodeficiency virus, 1 with acquired immunodeficiency syndrome and Kaposi sarcoma, 3 with emphysematous epiglottitis, 1 with abscess formation, and 1 with laryngeal carcinoma. One patient required emergency tracheostomy. One patient died of pneumonia.


RESULTS
The ratio of the soft-tissue parameters to the anteroposterior width of the C-4 vertebral body yielded three key parameters of high statistical significance in adult epiglottitis. The ratio of the width of the epiglottis to the anteroposterior width of C-4 should not be greater than 0.33 (sensitivity, 96%; specificity, 100%). The ratio of the prevertebral soft tissue to C-4 should not exceed 0.5 (sensitivity, 37%; specificity, 100%) and the ratio of the width of the hypopharyngeal airway to the width of C-4 should be less than 1.5 (sensitivity, 44%; specificity, 87%). The aryepiglottic folds were enlarged in 85%, and the arytenoids were swollen in 70% of the patient population (specificity, 100%).


CONCLUSIONS
These defined radiologic parameters should aid in the diagnosis of acute epiglottitis in adults.
Nemzek
W R
WR
Department of Diagnostic Radiology, University of California Davis Medical Center, Sacramento 95817, USA.
Katzberg
R W
RW
Van Slyke
M A
MA
Bickley
L S
LS
D017088:AIDS-Related Opportunistic Infections / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000000981:diagnostic imaging*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging; D004826:Epiglottitis / Q000000981:diagnostic imaging*; D005260:Female; D006192:Haemophilus Infections / Q000000981:diagnostic imaging; D006801:Humans; D007819:Laryngeal Edema / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000000981:diagnostic imaging; D011859:Radiography; D012016:Reference Values; D013290:Streptococcal Infections / Q000000981:diagnostic imaging