Abstract
Objective
An epiglottic abscess is considered a life-threatening medical situation that can cause death by obstruction the upper airways. We describe a 58-year-old man who presented to our hospital with sore throat, dysphagia and dysphonia.
Materials and methods
A fiberoptic laryngoscope (FOL) demonstrated beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. CT scan showed multiple air bubbles inside the swollen epiglottis, in keeping with the diagnosis of necrotizing epiglottic abscess.
Results
Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis. He was dismissed 5 days from his admission to the hospital after an improvement was noticed in his epiglottis.
Conclusion
Treatment consists of airway management if needed under anesthesia and draining of the abscess. An IV antibiotics plus corticosteroids should be administrated the moment a suspicion of epiglottitis is present.
1
Introduction
Epiglottitis is an acute infection of the epiglottis that can lead to death by obstructing the upper airways. Mostly, the infection is bacterial and is caused by Haemophilus influenzae type b (Hib); however, since the introduction of its vaccine in 1985, the incidence of epiglottitis had markedly dropped, especially in the pediatric population . In adults, on the other hand, it is still controversial whether there is a corresponding change in incidence. Some authors showed that the annual incidence remained stable ,while others report an increase or a decrease in the incidence of acute epiglottitis after the Hib vaccination.
Epiglottic abscess is a known medical entity, occurring in up to 24% of cases of acute epiglottitis in adults . The abscess is formed by the coalescence of the epiglottic inflammatory process or from infection of an epiglottic mucocele , and it is found most often on the lingual surface of the epiglottis . A patient with an epiglottic abscess may exhibit each of the following symptoms: dysphagia, odynophagia, dysphonia and stridor. We present a patient suffering from an epiglottic abscess which is unique in its radiologic findings.
2
Case presentation
A 58-year-old man presented to the emergency ward with sore throat, dysphagia and fever which started 3 days prior to his admission. He also complained of neck swelling and dysphonia, both started at the day of his admission. Medical history is as follows: S/P CVA 14 years prior to his admission, diabetes mellitus for 7 years, and hypertension and dyslipidemia for 14 years. He was taking all his medicine appropriately and all diseases were well controlled.
Upon arrival, his vital signs were as follows: temperature 38.2 °C, blood pressure 110/71, pulse 105 and saturation 94%. On physical examination the patient was not in distress; he was breathing quietly without stridor or dyspnea and was not drooling. Flexible fiberoptic endoscopy (FOL) showed a beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. His WBC count was 19,000 with 14,300 neutrophils. Treatment consisted of IV amoxicillin and clavulanate 1 g three times a day and IV methylprednisolone 125 mg, and he was hospitalized at the Department of Otolaryngology.
After 2 days of treatment the patients felt better with less odynophagia and he had no fever. However, repeat fiberoptic examinations did not show improvement, therefore, a CT scan was ordered. On a neck CT scan ( Figs. 1–4 ) we noticed multiple air bubbles inside the swollen epiglottis all anterior to the epiglottic cartilage that blocked partially the upper airway, in keeping with the diagnosis of epiglottic abscess. Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis and about 1 cc of pus was extracted and was sent to the bacteriology lab. The patient declined a formal incision and drainage of the abscess under anesthesia. He continued to improve and was discharged 4 days later. Culture from the pus revealed mixed polymicrobial colonies. Blood cultures, on the other hand, did not show any bacterial growth. Upon discharge all former symptoms resolved. A final FOL revealed a normal and healthy epiglottis with regression of the whole inflammatory process.
One month later he was seen in clinic. A revision of the larynx by FOL demonstrated a completely normal epiglottis, without any pathological findings.
2
Case presentation
A 58-year-old man presented to the emergency ward with sore throat, dysphagia and fever which started 3 days prior to his admission. He also complained of neck swelling and dysphonia, both started at the day of his admission. Medical history is as follows: S/P CVA 14 years prior to his admission, diabetes mellitus for 7 years, and hypertension and dyslipidemia for 14 years. He was taking all his medicine appropriately and all diseases were well controlled.
Upon arrival, his vital signs were as follows: temperature 38.2 °C, blood pressure 110/71, pulse 105 and saturation 94%. On physical examination the patient was not in distress; he was breathing quietly without stridor or dyspnea and was not drooling. Flexible fiberoptic endoscopy (FOL) showed a beefy red edematous epiglottis with edema extending from the base of the tongue to the aryepiglottic folds and arytenoids. His WBC count was 19,000 with 14,300 neutrophils. Treatment consisted of IV amoxicillin and clavulanate 1 g three times a day and IV methylprednisolone 125 mg, and he was hospitalized at the Department of Otolaryngology.
After 2 days of treatment the patients felt better with less odynophagia and he had no fever. However, repeat fiberoptic examinations did not show improvement, therefore, a CT scan was ordered. On a neck CT scan ( Figs. 1–4 ) we noticed multiple air bubbles inside the swollen epiglottis all anterior to the epiglottic cartilage that blocked partially the upper airway, in keeping with the diagnosis of epiglottic abscess. Under local anesthesia we performed puncture of the abscess at the tip of the epiglottis and about 1 cc of pus was extracted and was sent to the bacteriology lab. The patient declined a formal incision and drainage of the abscess under anesthesia. He continued to improve and was discharged 4 days later. Culture from the pus revealed mixed polymicrobial colonies. Blood cultures, on the other hand, did not show any bacterial growth. Upon discharge all former symptoms resolved. A final FOL revealed a normal and healthy epiglottis with regression of the whole inflammatory process.
