Characteristic thumb sign in epiglottitis

Abstract

Thumb sign is detected in simple lateral neck radiograph (preferably in upright view with neck in extension). Diagnosis can be confirmed by direct examination of pharynx, which reveal swollen epiglottis and can be confirmed by direct naso-pharyngo-laryngoscope. However this should be performed in an operating room where facilities to secure air way are available. Diagnostic investigations like CT can reveal other findings like thickening of epiglottis, thickening of ari-epiglottic fold and prevertebral fascia. Suspicion of an abscess may be deduced from evidence of multiloculated density collections in the neck.