Functional airway obstruction mimicking tongue angioedema

Functional causes of upper airway obstruction have focused primarily on psychogenic stridor associated with paradoxical vocal cord dysfunction. Angioedema can involve upper airway structures and be life-threatening.

We report a 12-year-old female with upper airway obstruction from posterior tongue swelling which was determined to be a conversion reaction.

A lateral neck film revealed severe tongue swelling. Examination revealed a calm, cooperative patient in no distress but exhibiting inspiratory and expiratory stridor. A computed tomography scan revealed soft tissue fullness at the base of the tongue without associated lymphadenopathy. Laboratory evaluation was normal. With anesthetic induction in the operating room, there was complete relaxation of the upper airway with no evidence of tongue swelling, mass, or other abnormality. Following tongue biopsy, she had no reoccurrence of the tongue mass.

This case represents a childhood conversion reaction of functional airway obstruction where tongue manipulation simulated tongue swelling radiographically consistent with angioedema.