A review was performed of 234 consecutive cases of epiglottis that occurred during a 20-year period to delineate the rate of, and clinical characteristics associated with, the complication of pulmonary edema. As a result of the prior utilization of a "dual" management protocol, there were 170 children who received endotracheal intubation, and 64 children managed without placement of an artificial airway. In all, five children (2.1%) of varying ages developed this complication--all experienced severe airway obstruction progressing to respiratory arrest, with evidence of pulmonary edema developing shortly after endotracheal intubation. Two of these five children died due to complications resulting from upper airway obstruction-induced cardiorespiratory arrest. By contrast, no child with milder degrees of airway obstruction managed without an artificial airway exhibited clinical evidence of pulmonary edema. Several possible mechanisms for the development of this complication are described. Pulmonary edema associated with epiglottitis is an uncommon complication that can occur following endotracheal intubation in those patients with marked respiratory insufficiency. An artificial airway should be instituted in all cases of pediatric epiglottitis--the potential complication of pulmonary edema should be anticipated before placement of an artificial airway, especially in those patients with a severe degree of upper airway obstruction.