Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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May 4, 2017
Emphysematous Supraglottitis
- Background:
- Relatively uncommon, potentially life-threatening infection
- Inflammation of supraglottic larynx in adults with sore throat and dysphagia
- Male to female ratio = 3:1; average age is 40–50 years; comorbidities include diabetes mellitus, malignancies (nasopharyngeal carcinoma, hepatocellular carcinoma), and history of acute supraglottitis
- Etiology: most commonly involved pathogens are S. pneumoniae, S. aureus, and N. meningitidis (H. influenzae rare in adults, but usual in children); viral and noninfectious causes less common
- Clinical Presentation:
- Sore throat and dysphagia most common symptoms
- Other symptoms include odynophagia, stridor, muffled voice, and difficulty in handling secretions (drooling)
- Key Diagnostic Features:
- Thickening/edema of supraglottic larynx (may involve tonsils and base of tongue)
- Epiglottis and aryepiglottic folds usually involved
- Differential Diagnoses:
- Supraglottic squamous cell carcinoma: commonly asymmetric infiltrating and enhancing mass
- Postactynic changes: supraglottic nonenhancing thickening; history of radiotherapy
- Epiglottitis: usually seen in children; no gas bubbles expected
- Laryngeal trauma: neck trauma history; extraluminal gas and cartilage deformity/injury
- Caustic injury: may only be appropriately differentiated with clinical history
- Treatment:
- Medical therapy with second generation cephalosporin (cefuroxime) and metronidazole; mean duration of antibiotic treatment is 10 days
- Steroids are controversial.
- Airway management (observation, intubation, or tracheostomy)
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