“Last week you had mentioned the radiographic soft issue sign on a lateral neck, the thumbprint sign as a good indicator of epiglottis. There are a few descriptions with 80-90 % sensitivities of a vellecula sign on the lateral soft tissue x-ray.

I have observed this sign, and can’t say that it was better or worse PPV or NPV that the epiglottis thumbprint, but in any instance that I am worried enough to obtain a soft tissue lateral of the neck, either awaiting for ct scan of unable to obtain e.g.patient can’t lay supine ( secretions, airway fear or comfort ) so a lateral neck is one of a limited choice, Having an additional sign has been helpful. Essentially the X-ray sign is a blunting of the sharp angle the epiglottis makes with the hypopharynx, where one is aiming for with a Macintosh blade. It would make sense that this space would reflect some early swelling, in an infectious process of the epiglottis.”

http://www.texasmedicalspa.com/assets/description-and-evaluation-of-the-vallecula-sign_a-new-radiologic-sign-in-the-diagnosis-of-adult-epiglottitis.pdf

Look up some images of the vallecula sign if you get a chance.

As always, thank you for all that you do!