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Neonatal respiratory distress syndrome revealing a cervical bronchogenic cyst: a case report.

Thaller P, Blanchet C, Badr M, Mesnage R, Leboucq N, Mondain M, Cambonie G - BMC Pediatr (2015)

Bottom Line: Proximal esophageal stenosis induced transient upper airway obstruction with salivary stasis.Decannulation was performed at 2 months and the patient was discharged 10 days later.In those situations, tracheostomy may be necessary for mechanical ventilation weaning and the initiation of oral feeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology and Pediatric Intensive Care Unit, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France. p-thaller@chu-montpellier.fr.

ABSTRACT

Background: Bronchogenic cyst is a congenital malformation, rarely located in the cervical region and almost never involved in a neonate with acute respiratory distress in the delivery room.

Case presentation: A female newborn with respiratory distress syndrome caused by a large left cervical mass. Intubation was difficult due to tracheal deviation. Magnetic resonance imaging confirmed a left cervical cyst displacing the trachea and esophagus laterally. Surgical excision was performed via a cervical approach on the 5th day, and pathological examination revealed a bronchogenic cyst. The patient's course was complicated by left vocal cord paralysis and necrotic lesions in the glottic and subglottic regions; she required a tracheostomy on the 13th day. Inflammatory stenosis in the subglottic region required balloon dilation once, 20 days later. Proximal esophageal stenosis induced transient upper airway obstruction with salivary stasis. Decannulation was performed at 2 months and the patient was discharged 10 days later.

Conclusion: A bronchogenic cyst can exceptionally obstruct the airways in the neonatal period. Surgical excision is necessary, but postoperative complications may occur if the cyst is in close contact with the trachea and esophagus, including necrotic and stenotic lesions of the upper aerodigestive tract. In those situations, tracheostomy may be necessary for mechanical ventilation weaning and the initiation of oral feeding.

No MeSH data available.


Related in: MedlinePlus

Postoperative endoscopy. Glottic region: anterior synechia (a) causing luminal stenosis of 50 %. Subglottic region: sutured tracheal wound (b) and inflammatory alterations causing grade 1 stenosis
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Fig2: Postoperative endoscopy. Glottic region: anterior synechia (a) causing luminal stenosis of 50 %. Subglottic region: sutured tracheal wound (b) and inflammatory alterations causing grade 1 stenosis

Mentions: After the first attempt at extubation on the day after surgery, the infant had respiratory distress due to laryngotracheal edema and left vocal fold paresis that was refractory to treatment with nebulized epinephrine and corticosteroids and required reintubation. The second attempt at 8 days postsurgery was equally unsuccessful. The upper respiratory tract was explored under general anesthesia at a postnatal age of 13 days. We observed edema of the left laryngeal ventricle and the anterior third of the glottis, associated with the necrotic appearance of the mucosa in the left lateral subglottis (Fig. 2). Such lesions in a newborn who could not be weaned from mechanical ventilatory support prompted immediate tracheostomy.Fig. 2


Neonatal respiratory distress syndrome revealing a cervical bronchogenic cyst: a case report.

Thaller P, Blanchet C, Badr M, Mesnage R, Leboucq N, Mondain M, Cambonie G - BMC Pediatr (2015)

Postoperative endoscopy. Glottic region: anterior synechia (a) causing luminal stenosis of 50 %. Subglottic region: sutured tracheal wound (b) and inflammatory alterations causing grade 1 stenosis
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4491209&req=5

Fig2: Postoperative endoscopy. Glottic region: anterior synechia (a) causing luminal stenosis of 50 %. Subglottic region: sutured tracheal wound (b) and inflammatory alterations causing grade 1 stenosis
Mentions: After the first attempt at extubation on the day after surgery, the infant had respiratory distress due to laryngotracheal edema and left vocal fold paresis that was refractory to treatment with nebulized epinephrine and corticosteroids and required reintubation. The second attempt at 8 days postsurgery was equally unsuccessful. The upper respiratory tract was explored under general anesthesia at a postnatal age of 13 days. We observed edema of the left laryngeal ventricle and the anterior third of the glottis, associated with the necrotic appearance of the mucosa in the left lateral subglottis (Fig. 2). Such lesions in a newborn who could not be weaned from mechanical ventilatory support prompted immediate tracheostomy.Fig. 2

Bottom Line: Proximal esophageal stenosis induced transient upper airway obstruction with salivary stasis.Decannulation was performed at 2 months and the patient was discharged 10 days later.In those situations, tracheostomy may be necessary for mechanical ventilation weaning and the initiation of oral feeding.

View Article: PubMed Central - PubMed

Affiliation: Department of Neonatology and Pediatric Intensive Care Unit, Hôpital Arnaud de Villeneuve, 371 Avenue du Doyen Gaston Giraud, 34295, Montpellier Cedex 5, France. p-thaller@chu-montpellier.fr.

ABSTRACT

Background: Bronchogenic cyst is a congenital malformation, rarely located in the cervical region and almost never involved in a neonate with acute respiratory distress in the delivery room.

Case presentation: A female newborn with respiratory distress syndrome caused by a large left cervical mass. Intubation was difficult due to tracheal deviation. Magnetic resonance imaging confirmed a left cervical cyst displacing the trachea and esophagus laterally. Surgical excision was performed via a cervical approach on the 5th day, and pathological examination revealed a bronchogenic cyst. The patient's course was complicated by left vocal cord paralysis and necrotic lesions in the glottic and subglottic regions; she required a tracheostomy on the 13th day. Inflammatory stenosis in the subglottic region required balloon dilation once, 20 days later. Proximal esophageal stenosis induced transient upper airway obstruction with salivary stasis. Decannulation was performed at 2 months and the patient was discharged 10 days later.

Conclusion: A bronchogenic cyst can exceptionally obstruct the airways in the neonatal period. Surgical excision is necessary, but postoperative complications may occur if the cyst is in close contact with the trachea and esophagus, including necrotic and stenotic lesions of the upper aerodigestive tract. In those situations, tracheostomy may be necessary for mechanical ventilation weaning and the initiation of oral feeding.

No MeSH data available.


Related in: MedlinePlus