The heat is on... thermal epiglottitis as a late presentation of airway steam injury

Sapna R Kudchadkar, Justin T Hamrick, Christine L Mai, Ivor Berkowitz, David Tunkel
Journal of Emergency Medicine 2014, 46 (2): e43-6

BACKGROUND: Thermal epiglottitis is a rare but potentially life-threatening disease. Diagnosis requires a thorough history and high clinical level of suspicion, particularly in children. Thermal epiglottitis from steam inhalation can have a slow onset without oropharyngeal signs of thermal injury, findings that can hide the clinical diagnosis.

OBJECTIVE: Our aim was to review the pathophysiology and clinical presentation of thermal epiglottitis and the challenges involved in diagnosis and management of this form of atypical epiglottitis.

CASE REPORT: We describe the case of a 22-month-old male presenting to the pediatric emergency department after a scald burn from steam and boiling water resulting in 12% body surface area burns to his chin, chest, and shoulder, with no obvious oropharyngeal or neck injuries. At the time of presentation, he was afebrile and well appearing. Six hours after the injury, he was sitting in the "tripod position," drooling, with pooled saliva in his mouth and inspiratory stridor. Intubation in the operating room using conventional direct laryngoscopy was not successful and he was intubated using an operative endoscope. Laryngoscopy demonstrated thermal epiglottitis. A tracheostomy was performed to secure the airway, and he was admitted to the pediatric intensive care unit. He was discharged home and decannulated 4 weeks later, when airway endoscopy showed complete recovery with normal airway structures.

CONCLUSION: A thorough history and physical examination together with a high level of suspicion and aggressive, collaborative airway management is vital in preventing catastrophic airway obstruction in atypical forms of epiglottitis.

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