In acute epiglottitis in an adult, the characteristic radiological finding on lateral soft tissue neck X-ray is:

• A Subglottic narrowing (steeple sign)
• B Prevertebral soft tissue widening only
• C Enlarged epiglottis (thumbprint sign) ✓
• D Calcification within the epiglottis

Explanation

Acute epiglottitis on lateral soft tissue neck X-ray shows the 'thumbprint' or 'thumb sign' — the swollen, rounded, radiopaque epiglottis resembling a thumb. This is in contrast to viral croup (laryngotracheobronchitis) which shows the 'steeple sign' (subglottic narrowing) on AP view. Immediate airway management takes priority; X-ray should not delay airway securing in a symptomatic patient with stridor.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.