Presentation
Acute onset of diffuse neck swelling associated with fever, voice hoarseness and odynophagia.
Patient Data
Significant fat stranding at the subcutaneous tissue over the lower anterior neck (more on the right side) is consistent with clinically observed neck cellulitis/swelling.
Thickened, edematous enhancing epiglottis and aryepiglottic folds, more pronounced in the aryepiglottic folds. Non-enhancing ill-defined fluid attenuating collection noted at the posterior aspect of supraglottis/hypopharynx, likely to represent phlegmon or submucosal edema. No rim-enhancing collection or abnormal air pocket to suggest abscess formation.
Partial stenosis of the airway at supraglottis.
Both valleculae and right pyriform sinus are effaced.
Thickened right strap muscle, right platysma and fat stranding at the right paraepiglottic fat space as well as subcutaneous tissue indicate inflammatory changes extending from the supraglottitis.
Enlarged right submandibular gland is in keeping with secondary inflammatory sialadenitis.
No thrombosis noted within bilateral carotid spaces vessels.
An enlarged right level II cervical lymph node, measuring 2.7cm in long axis dimension.
No retropharyngeal collection and superior mediastinitis.
Flexible nasopharyngoscopy performed showed thick endolaryngeal mucoid at bilateral pyriform fossae. Bilateral arytenoids and aryepiglottic folds are edematous and erythematous. Edematous epiglottis. Both vocal cords are mobile and airway is still patent.
Case Discussion
Supraglottitis is the adult form of epiglottitis. It is characterized by thickened epiglottis, aryepiglottic folds, and mucosal enhancement.
As in this case, no CT features to suggest abscess formation for drainage. The ill-defined low attenuating collection represents phlegmon. Differentiation between abscess and phlegmon are crucial for determining the type of treatment/management. Patient is managed with intravenous antibiotics and steroids.
Airway patency is utmost importance in order to present respiratory compromise.
Patient has uncontrolled diabetes with high blood glucose at the time of presentation which is one of the important causes for infection.
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