A lateral neck radiograph showing which sign is classic for epiglottitis?

• A. Thumb sign
• B. Double bubble sign
• C. Signet sign
• D. Steeple sign

Answer: (A)

The main idea is recognizing the classic radiographic sign of epiglottitis on a lateral neck view. When the epiglottis becomes acutely inflamed and swollen, it puffs up forward and appears as a rounded, thick anterior projection that looks like a small thumb sticking out over the airway—the thumb sign. This image reflects significant supraglottic edema and impending airway obstruction, which is why it is treated as a medical emergency with prompt airway management and antibiotics.

Context helps: epiglottitis used to be more common in children before Hib vaccination and remains a critical diagnosis to consider in a febrile child with drooling and respiratory distress. The other signs point to different conditions: the steeple sign is subglottic narrowing seen with viral croup on an AP view, the double bubble sign indicates duodenal atresia, and the signet sign is not the classic feature of epiglottitis.