Double thumb sign in a case of epiglottitis

Epiglottitis is a potentially life-threatening condition that requires quick and accurate diagnoses. The gold standard for diagnosis is for laryngoscopic visualisation of the epiglottis. However, this may not be well-tolerated in a patient with impending airway collapse, and lateral neck radiographs may support the diagnosis. The thumb sign is a recognized radiological feature of epiglottitis. We present a case of a 57-year-old gentleman with epiglottitis, whose lateral neck radiograph had the interesting feature of a double thumb sign. In spite of the significant airway oedema, he was conservatively managed with subsequent full recovery. The objective of this case report is to highlight the severity of airway narrowing with this radiological finding of double thumb sign, to alert the clinician to have closer monitoring or to consider artificial airway support.