The given clinical picture along with the X-ray shows thumb sign , this finding suggests a diagnosis of Acute Epiglottitis. Thumb sign is a term also used in other conditions: Thumb sign (Marfan disease) (also known as Steinberg sign): a clinical test in which the tip of the thumb is visible medial to the little finger when it is clasped in the clenched hand. Thumb sign (chordoma): a radiological sign showing a clival tumour projection indenting the pons.