IntroductionAcute epiglottitis and epiglottic abscess are forms ofstru - PDF document

IntroductionAcute epiglottitis and epiglottic abscess are forms ofstructures. They are potentially life-threatening condi-tions and likely to be underdiagnosed or misdiagnosedin adults. Traditionally, acute epiglottitis is regarded asa disease of children; however, its prevalence amongchildren has decreased owing to vaccination. In con-trast, the prevalence of adult epiglottitis has increasedsteadily. Moreover, epiglottic abscess formation is notan uncommon complication of adult epiglottitis.Epiglottic abscess is reported to be a predictor of air-way obstruction and immediate airway intervention isneeded in this clinical situation [1]. Herein, we de-scribe the autopsy findings of two cases of suddendeath from acute epiglottitis complicated by epiglotticabscess in adults, identified during postmortem exami-Case ReportsAccording to the police report, a 39-year-old man whowas being treated in a psychiatric hospital for schizo-vital signs were blood pressure of 140/90 mm Hg,pulse rate of 98 per minute, respiration rate of 18breaths per minute, and body temperature of 37.5matory drug injection, the patient suddenly developed http://dx.doi.org/10.7580/kjlm.2015.39.2.49 Sudden Death from Acute Epiglottitis and EpiglotticAbscess in Adult Sang Jae Noh, Ho Lee Departneot of Foreosjc Nedjcjoe-Choobul Oatjooam Uojversjtz NedjcamSchoom- 567 Baelke.daero- Deolkjo. the incidence is extremely rare, acute epiglottitis is a life-threatening medical emer- 
 respiratory failure. Cardiopulmonary resuscitation(CPR) was performed by the medical staff, but the pa-symptoms. Previous medical records indicated thatthe patient had no medical health problems exceptschizophrenia. Autopsy findings indicated that hisheight was 181 cm and body weight was 87 kg.External examination indicated the presence of CPR-Internal examination revealed that the right and leftlungs weighed 1,123 g

and 928 g, respectively, withboth bronchi were filled with white froth; the heartweighed 470 g and showed petechiae and stenosis ofthe right coronary artery; the epiglottis was erythema-tous and swollen with cystic changes on the lingualAccording to the police report, a 66-year-old man visit-prior to his death. Two days prior, he had receivedsymptoms did not improve. Physical examination re-vealed redness of the throat only; however, laryngo-scopic examination failed to provide an adequate viewof the laryngeal structures. For diagnosis and propermanagement, the patient was transferred to a largerhospital. During transfer, his symptoms worsened andhe developed respiratory arrest. Resuscitation was per-formed but he failed to recover and died. His familyreported that he had taken medication for hyperten-sion. Autopsy findings indicated he was 178 cm tallwith ordinary body type. Internal examination re-vealed that the right and left lungs weighed 1,245 gand 1,050 g, respectively, with edema and petechiaeon the pleural surface. The heart showed petechiaeand mild coronary artery stenosis. The epiglottis wasseverely edematous and erythematous and there wasa focal yellowish color change along the rightaryepiglottic fold (Fig. 1B). Both tonsils were normal.In both the cases, microscopic examination of theepiglottis revealed numerous acute inflammatory cellsconnective tissues (Fig. 2). These findings were consis-tent with epiglottitis and epiglottic abscess. There wasno evidence of alternative lethal diseases or injuries tobe the cause of death and no toxic agents or alcoholwas detected.Loreao Kouroam of Megam Nedjcjoe│2015<3:;4:.52 A Fig. 1.(A) Case 1: diffuse swelling ofepiglottis with redness and cysticdilation on the right lingual surface(arrowhead). (B) Case 2: diffuseswelling of epiglottis with theformation of visible, yellowish abscessalong the right aryepiglo

ttic fold(arrow). Acute epiglottitis is a lethal condition and usually oc-type B vaccination, there hasin the pediatric population. However, the incidence ofadult epiglottitis has not decreased and acute epiglotti-tis has mostly become a disease of adults [2]. The an-dents has ranged between 0.88 and 3.10 and is in-creasing. The individuals affected tend to be predomi--The major cause of epiglottitis is a primary infectiondue to Haemophilus influenzaetype B or Streptococcusspp. in all age groups. major cause of adult epiglottitis [2]. In most cases,there is a low probability of identifying the causativepathogen by blood or respiratory tract cultures.and the inhalation of drugs and chemical agents. than in children. The prevalence of abscess is two-foldhigher among those who need airway intervention [1].acute epiglottitis in adults is slower than that in chil-diameter [4,5]. The slow-progressing nature of adultepiglottitis contributes to the frequent formation of ab-scess in adults due to prolonged inflammation and co-alescence. Epiglottic abscess may result from a coales-epiglottic retention cyst. Epiglottic abscess may alsooccur after radiotherapy for laryngeal cancer [4].Anatomically, the lingual surface of the epiglottis iscommonly involved [1]. In the present study, the pa-tient in case 1 had a cystic dilation of the lingual sur-face of the epiglottis and there was a visible yellow-colored abscess along the aryepiglottic fold in case 2. In many cases of adult epiglottitis, the patients havecomorbid diseases such as diabetes, hypertension, al-coholism, hepatitis, and malignancy [1,6,7]. The pa-tient in case 2 received medication for hypertensionfor a long time. Occasionally, death from epiglottic ab-scess occurs in patients with psychotic disorders suchchotic disorders suchdetection of the disease at an early stage. Furthermore,caustic and thermal epiglottit

is due to ingestion of for-eign materials is more likely to occur in patients withmental disorders [9,10]. In case 1, the patient was hos-pitalized for schizophrenia and complained of a sorethroat and dyspnea. Airway obstruction progressedof his symptoms. abscess in adults for clinicians and forensic patholo-gists. In the two cases reported herein, patients diedmedico-legal autopsies were requested to assess thegeal examination can be overlooked. We recommendconsidering a diagnosis of epiglottitis and a careful ex-amination by clinicians and forensic pathologists.Furthermore, it is important to remember that epiglot-Acute Epjgmottjtjs aod Epjgmottjc jo Adumt│Saog Kae Ooh- et am/ Fig. 2. Microscopic finding of epiglottitis and epiglottic abscess,with dense infiltration of neutrophils and necrotic material inmucosal and submucosal tissues (H&E, tic abscess can develop frequently in patients withadult epiglottis, particularly among those with comor-bidities, such as diabetes, hypertension, and mentaldisorders.No potential conflict of interest relevant to this articlewas reported.References1.Berger G, Landau T, Berger S, et al. The rising incidence2.Isakson M, Hugosson S. Acute epiglottitis: epidemiology3.Guldfred LA, Lyhne D, Becker BC. Acute epiglottitis: epi-demiology, clinical presentation, management and out-4.Harvey M, Quagliotto G, Milne N. Fatal epiglottic abscessafter radiotherapy for laryngeal carcinoma. Am J Forensic5.Stack BC Jr, Ridley MB. Epiglottic abscess. Head Neck6.Hindy J, Novoa R, Slovik Y, et al. Epiglottic abscess as a7.Shah RK, Stocks C. Epiglottitis in the United States: na-8.Yang KM, Jung NE, Kim JK, et al. Sudden death due to9.Kahn MW, Miovic M, Perez-Cahill D. Epiglottitis in a psy-10.Kornak JM, Freije JE, Campbell BH. Caustic and thermalepiglottitis in the adult. Otolaryngol Head Neck SurgLoreao Kouroam of Megam Nedjcjoe│2015<3:;4:.