Infantile asphyxia due to aberrant uvula--an anatomic misadventure

A case of unexpected death of an infant with an abnormally elongated uvula is presented. The child, born prematurely, was recovering from protracted treatment in hospital, including surgical interventions and periods of ventilation support necessitating recurrent intubations and anesthesia. She was discharged home in good general health, affected by episodes of cough, and was found dead in her crib a week later. The proximity of the aberrant uvula to the vocal cords may have caused intermittent laryngospasm, with subsequent symptoms of cough and airway obstruction, ending in a fatal outcome. Recurrent airway irritation may have contributed to uvular hypertrophy, due to inflammatory and reactive changes. It is pertinent for the pathologist to thoroughly examine the structures of the pharynx, and the uvula in particular, in any case of pediatric death suspected to result from asphyxia or sudden infant death syndrome (SIDS).