Thumb printing sign is seen in

(Acute epiglottitis): (309-Dhingra 5th; 599-P-Hazarika 3rd/edition)ACUTE EPIGLOTTITIS(Syn - Acute supraglottic laryngitis)* Caused by Hemophilus influenza type BClinical FeaturesSymptomsSignsGeneral - usually starts as URTISigns* High grade fever* General - fever, toxic appearance and flushed skin, lethargic* Dribbling saliva* On auscultation decreased air entry Local* Sore throad* Dysphagia/odynophagia* Muffled (Hot potato) voice* F B sensation in the throat* Breathing difficulty -Inspiratory stridor is variably present and may be associated with expiratory rottles ORAL* Pharynx is usually congested and pooling of saliva* Red and edematous epiglottis popping up "Cherry red epiglottis"* Stridor is inspiratory and increases on supine position. Patient tends it sit up leaning forward supporting on upper limbs (Tripod sign) which relieves stridor to some extent* Inspiratory stritor if severe causes intermittent retraction, active accessory respiratory muscles and perioral cyanosis Differences between acute epiglottis and acute laryngo-tracheo-bronchitis in children Acute epiglottisAcute laryngo-tracheo-bronchitis (or group)* Causative organismHaemophilus influenza type BParainfluenza virus type I and II* Age2-7 years3 months to 3 years* PathologySupraglottic larynxSubglottic area* Prodromal symptomsAbsentPresent* OnsetSuddenSlow* FeverHighLow grade or no fever* Patient's lookToxicNon-toxic* CoughUsually absentPresent, (Barking seal-like)* StridorPresent and may be markedPresent* OdynophagiaPresent with drooling of secretionsUsually absent* RadiologyThumb sign on lateral viewSteeple sign on anteroposterior view of neck* TreatmentHumidified oxygen, third generation cephalosporin (ceftriaxone) or amoxicillinHumidified 02 tent, steroids