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Laryngeal papillomatosis presenting as acute airway obstruction in a child
C B Reeber1, E J Truemper, J P Bent
1Department of Emergency Medicine, Medical College of Georgia, Augusta, USA.
Insights
Upper airway obstruction in children can mimic lower airway disease, leading to misdiagnosis. A rare laryngeal papilloma caused respiratory arrest in a child previously treated for asthma.
Area of Science:
- Pediatric Emergency Medicine
- Otolaryngology
- Respiratory Diseases
Background:
- Upper airway obstruction in children can be misdiagnosed as lower airway disease.
- Ineffective treatments for asthma suggest a potential underlying obstructive issue.
- Progressive obstruction can lead to life-threatening respiratory compromise.
Observation:
- A pediatric patient with asthma, unresponsive to treatment, presented with respiratory arrest.
- The patient's history of poorly responsive asthma was a key factor.
- Respiratory arrest occurred despite standard outpatient management.
Findings:
- The cause of respiratory arrest was a large laryngeal papilloma.
- Laryngeal papilloma is a rare cause of airway obstruction in children.
- This diagnosis was unexpected for emergency physicians.
Implications:
- Highlights the importance of considering upper airway obstruction in pediatric respiratory distress.
- Emphasizes the need for thorough diagnostic evaluation when initial treatments fail.
- Underscores the critical role of recognizing rare conditions in emergency settings.
Abstract:
Upper airway obstruction, regardless of cause, can masquerade or be misdiagnosed as lower airway disease in children. In such cases, therapeutic trials of antibiotics, bronchodilators, and over-the-counter medications for symptom relief routinely fail; however, the original diagnosis often goes unchallenged. If the obstructive process is progressive, then acute occlusion of the airway may occur, rapidly leading to suffocation and death if resuscitation is unsuccessful. Outlined in this report is the case of a young female with a history of asthma, poorly responsive to outpatient treatment, who presented with respiratory arrest. The cause of the respiratory collapse was later identified as a large laryngeal papilloma, a condition rarely encountered by emergency physicians.