A 3-year-old girl is brought by her parents into the pediatrician for an urgent evaluation. The child recently started running a high fever in addition to refusing to eat or drink anything. She appears uncomfortable on her mom's lap, leaning very far forward. She is also drooling a fair amount. A cervical radiograph is shown. What is the most likely explanation for this finding?

Ans. (a) Thumb sign.Epiglottitis is an infection of the epiglottis which can lead to upper airway obstruction. It is most commonly seen in ages 3 to 6 years, and is most commonly caused by Haemophilus influenza B (HIB). The incidence has decreased 90% since the introduction of the HIB vaccine. Children present with fever, sore throat, and severe odynophagia. They appear sitting up and leaning forward, drooling. They may have biphasic stridor, especially when presenting later. Epiglottitis can be detected radiographically with a lateral cervical plain film, which shows the characteristic "thumbprint sign.' This sign is caused by the thickened epiglottis.Image source- style="font-family: Times New Roman, Times, serif">