Acute laryngeal stridor--controversies in current management.
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A case of tracheal cyst is described in a 43-year-old man who was admitted with nonspecific symptoms of an obstruction in the upper respiratory tract. A CT scan of the thorax showed a solid tumor on the inner tracheal wall. Bronchoscopy revealed a tumor with a broad base and smooth surface that almost completely obstructed the trachea. Intraoperatively, the tumor was found to be a cyst and was successfully removed endoscopically. Tracheal cysts are quite rare and most of the reported cases have been confined to pediatric patients as a congenital disease. More frequently, congenital intraluminal cysts of the upper respiratory tract are found as epiglottic retention cysts and laryngoceles.
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A male patient presented at day 3 of life with a small anterior neck mass and mild intermittent upper airway obstruction. Despite intravenous antibiotics, the patient rapidly progressed to impending airway obstruction requiring surgical intervention. The clinical, radiographic, and histologic findings of this extremely rare case of a third branchial anomaly will be presented. The embryologic basis for the connection to the aerodigestive tract and the access provided to gram negative enteric organisms in newborns will be discussed.
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We report the case of a young man who presented to 3 emergency departments with apparent upper airway obstruction and was intubated each time before being diagnosed with paradoxical vocal cord motion. His previous discharge diagnoses were laryngeal edema secondary to anaphylaxis, even though he had no other objective findings of IgE-mediated disease. Flexible fiberoptic laryngoscopy demonstrated tight apposition of the vocal cords during inspiration while symptomatic, but normal movement when asymptomatic. Psychiatric evaluation revealed severe posttraumatic stress disorder. Of the approximately 41 reported cases of functional airway obstruction in the medical literature, only two have been adult males and none have been associated with posttraumatic stress disorder. The current literature is reviewed, and an approach to evaluation and management of such patients is provided.
Intratracheal thyroid is a rare cause of upper airway obstruction. The obstruction may be true ectopic thyroid tissue or may be caused by invasion of the trachea by a malignant process. We present a case of true ectopic thyroid which illustrates the presentation and management of the condition. The pathogenesis of intratracheal thyroid has been postulated by several authors; here we discuss these rival theories. Because intratracheal thyroid is a rare condition, it may not always be considered early on in case of upper airway obstruction--by presenting this case we hope to remind others of it.
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