Challenges in Diagnosing Adult Epiglottitis: Limitations of CT Scan

Abstract

Adult Epiglottitis (AE) is a life-threatening but uncommon condition which presents with non-specific symptoms such as sore throat and odynophagia. Because CT scan is readily available in the Emergency Department (ED), it is often used to evaluate adult patients with AE when laryngoscopy is not available and examination inadequate and to exclude other ENT (Ear, Nose and Throat) emergencies. However, up to this date, there is no report of CT scan accuracy in evaluating AE in our literature. Our case is a 26 year old African American female who complains of sore throat and odynophagia after she ate at a barbecue 8 hour prior to the ED visit. On examination, VS (Vital Signs) were stable, throat revealed marked erythema without any peritonsillar abscess. Neck was supple without any cervical adenopathy - Chest=clear, no rales/ronchi - The rest of the exam was within normal limits. Initial CT scan of the neck was read as normal by the on call Radiologist. A direct laryngoscopy had shown findings consistent with acute epiglottitis. Repeat CT scan 24 hours after ED visit confirmed the diagnosis of AE. Patient was started on IV steroids and antibiotics and admitted to ICU. Our case illustrates the challenges facing the Emergency Physicians in diagnosing AE. It reports the role and limitations of CT scan in evaluating AE in the ED.