Spontaneous Tracheal and Subglottic Tears in Neonates

Objectives/Hypothesis Spontaneous rupture of the trachea or subglottis as a complication of difficult delivery has not been reported in the United States literature. There have been a few cases reported in the European literature. The present report describes a series of newborns with this complication and discusses the signs and treatment options of this difficult, life‐threatening problem. Study Design Retrospective review. Methods Newborns born between 1996 and 2001 who were treated for spontaneous subglottic or tracheal rupture at a tertiary care children's hospital neonatal intensive care unit were reviewed. Results Four cases of spontaneous subglottic rupture were seen at the hospital. In three of the four cases the tracheas were emergently intubated after subcutaneous air was noted in the anterior aspect of the neck. In the fourth patient the trachea was not intubated until the subglottic tear was visualized intraoperatively. Two of the four patients died. One died without securing of an airway; the other died of complications of prolonged hypoxia. Eight cases from European literature of spontaneous neonatal subglottic and tracheal tears are reviewed and are compared with the cases presented in the current report. Conclusions Early detection of airway rupture by flexible endoscopy is essential for timely diagnosis and appropriate treatment. Standard endotracheal intubation can exacerbate the problem and should be deferred if possible until direct airway visualization can be accomplished. Signs associated with tracheal tears include subcutaneous emphysema, respiratory distress, pneumothorax, and pneumomediastinum. These should lead to emergent consultation with otolaryngologists for examination and securing of the airway.     

Tracheal diverticulum: A case report and literature review

Purpose

Tracheal diverticulum (TD) is a rare, nonspecific symptom that is commonly associated with other malformations in clinical presentation and appearance on imaging. The case presented and the literature review performed highlight the importance of combining 3 D reconstruction technology and computerized Tomography (CT) results to better characterize TD on the list of differential diagnoses of patients.

Methods

The case described is of a 44-year-old male with a 1-year history of repeatedly coughing with white phlegm. Computerized tomography and three dimension reconstruction technology were employed to diagnose tracheal abnormalities. The patient underwent surgical resection of the tracheal diverticulum. Reexamination of the neck, chest, trachea and lungs of the patient was performed with CT scan post operation.

Results

Chest CT confirmed the presence of the air cavity lesion behind the neck segment and may be the trachea cysts. Bronchoscope examination was all normal. Furthermore, HRCT scan and the tracheal reconstruction were performed (as shown in Fig. 1), which show cystic cavity lesion was on right rear trachea and a tiny tha was connected the tracheal posterior wall. Post-operation, reexamination showed that the neck, chest CT, trachea and lungs had no detectable abnormity.

Conclusion

Diagnostic techniques such as HRCT and 3D reconstruction technology may help to diagnose the tracheal diverticulum timely and accurately. Resection of the diverticulum is the proper surgery, but only for symptomatic congenital diverticulum; therefore preoperative definite classification is important (acquired or congenital diverticulum).     

Neuroblastoma and life-threatening tracheal obstruction: A case report and literature review

Thoracic neuroblastoma is a rare cause of life-threatening tracheal compression in paediatric oncology. We describe the case of a 5-month old boy with a 2-week history of progressive stridor, a right supraclavicular mass, a paravertebral/mediastinal mass on imaging and elevated urinary catecholamines. In view of the patient's threatened airway, a multidisciplinary management plan was agreed upon prior to obtaining a biopsy to confirm the diagnosis of neuroblastoma. Preoperative microlaryngobronchoscopy (MLB) demonstrated critical tracheal compression necessitating intubation. Neuroblastoma was confirmed on histology. Urgent cytoreductive treatment was initiated with excellent response allowing extubation 14 days later.     

Tracheal agenesis. A case report and literature review

Tracheal agenesis (TA) is a rare congenital anomaly that is incompatible with prolonged life. It occurs in isolation or in association with other anomalies. The affected neonate presents with respiratory distress and is unable to produce an audible cry despite obvious physical effort. A difficult intubation ensues, and often only during a postmortem examination is the diagnosis of TA made. It is hoped that in addition to adding the 47th case of TA to the literature, this article will provide some insight into the pathogenesis, presentation, and management of this anomaly. It must be emphasized that as TA carries a fatal prognosis, great care must be taken in establishing the diagnosis. If the diagnosis is confirmed, complex reconstructive surgery is not recommended as it has not been shown to change the prognosis or clinical course of affected neonates.     

Tracheal invasion and perforation from advanced primary thyroid lymphoma: A case report and literature review

Objective

We report a case of an elderly female with primary diffuse large B-cell thyroid lymphoma causing an extensive tracheal defect that was managed expectantly with good results.

Method

Case report

Results

This is the only known reported case of a patient with tracheal invasion and perforation caused by primary thyroid lymphoma who has subsequently survived.

Conclusion

Due to the rarity of invasive primary thyroid lymphoma there is currently no standard surgical management of the airway. We propose that expectant management with temporary airway protection is an alternative to invasive procedures such as tracheotomy or tracheal stent placement, even in the scenario of serious airway defects.     

Osteoradionecrosis of the hyoid bone complicated by pharyngocutaneous fistula: A case report and literature review

Background

Osteoradionecrosis (ORN) is a well-known complication following irradiation of head and neck malignancies. ORN commonly occurs in the mandible but is rarely reported in the hyoid bone.

Esthesioneuroblastoma: A case report and review of the literature

Esthesioneuroblastoma (ENB) is an extremely rare malignant neoplasm of the nasal cavity. We report the case of a middle aged man who presented with a 6-months history of progressive nasal obstruction, watering of the eye, headache and occasional epistaxis. A diagnosis of esthesioneuroblastoma was established by histopathology and confirmed by immunohistochemistry. On staging the mass was classified as a kadish stage C tumor. The mass was excised via a craniofacial resection through a bi-coronal approach and the tumor mass was peeled away completely from the frontal lobe dura. The patient underwent postoperative radiation, and he was free of recurrence at follow-up 3 months later.     

TACRD and VACTERL associations in a fetus: Case report and review of the literature

Tracheal agenesis is a rare and potentially lethal congenital anomaly. The incidence is less than 1/50,000, with a male:female ratio of 2:1. We report the case of a male fetus with complete agenesis of the trachea and a tracheoesophageal fistula arising from the esophagus that connected through the carina, as well as several abnormalities (congenital cardiac abnormalities, duodenal atresia, vertebral defects, anal atresia, renal defects, limb defects, and diaphragmatic hernia). To our knowledge, few cases of infants with VACTERL or TACRD association have been reported to date. Here, we report a new case of a fetus that showed the full range of VACTERL and TACRD associations.     

Dual thyroid ectopia: A case report and literature review

Ectopic thyroid gland is a type of thyroid dysgenesis which also includes abnormalities such as thyroid hemiagenesis and persistent thyroglossal duct tracts. These abnormalities occur anywhere from 1 in 100,000 to 300,000 live births. Only 30 cases of dual thyroid ectopia have been reported. The authors present a case of dual thyroid ectopia to discuss diagnostic and management strategies. The study is a case report encountered at a tertiary health care center. The etiology, diagnosis, and treatment of dual thyroid ectopia are discussed.     

外耳道胆脂瘤并发化脓性腮腺炎1例并文献复习

目的 探讨外耳道胆脂瘤并发化脓性腮腺炎病因及诊治经验,并进行外耳道胆脂瘤诊疗相关文献复习。 方法 回顾性分析1例外耳道胆脂瘤并发化脓性腮腺炎病例资料,主要症状为左耳听力下降伴流脓,左侧面部红肿疼痛。颞骨CT及耳部核磁示:左侧外耳道内胆脂瘤形成,累及乳突、鼓室、鼓窦、腮腺及咽旁间隙。临床诊断:外耳道胆脂瘤(左,Holt Ⅲ期)、化脓性腮腺炎(左)。手术方式为左耳外耳道胆脂瘤切除术、开放式乳突根治术、鼓室成形术、人工听骨植入术、耳甲腔成形术、腮腺脓肿清除术及腮腺瘘修补术。 结果 术中彻底清除外耳道及中耳内胆脂瘤及腮腺脓肿,并修复腮腺瘘。术后随访患者恢复良好,无胆脂瘤复发残留及腮腺炎复发相关症状出现。 结论 外耳道胆脂瘤具有骨质破坏的潜能。而HoltⅢ期外耳道胆脂瘤并发化脓性腮腺炎病例罕见,明确病因并依据病变侵袭范围选择个体化的治疗方案尤为关键。     

Epignathus. A case report and review of the literature

Epignathus is an uncommon form of oropharyngeal teratoma that is associated with a high mortality during the neonatal period. We report the clinical case of a neonate born through cesarean in week 35, Apgar 2-4, neurologic breakdown and widespread hypotonia. The prenatal diagnosis was performed by ultrasonography; the diameter of the solid mass was 5 cm with inner calcium density. An urgent tracheostomy was carried out as it was not possible to get orotracheal intubation (IOT) and, later, we proceeded to remove the mass which was embedded in the hard palate. Our patient died three weeks later due to respiratory and heart failure. We carry out a review of the literature for this pathology.     

Rhabdomyosarcoma of the larynx: A case report and review of the literature

Rhabdomyosarcoma is rarely diagnosed in the larynx. A case report and five patients from the Otolaryngic Pathologic Files of the Armed Forces Institute of Pathology are added to the world literature. Current modes of treating Stage III rhabdomyosarcomas are reviewed. The recent literature suggests that certain of these neoplasms may be treated successfully without radical surgery.