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An Unusual Case of Noisy Breathing in an Infant
Carmen Leon-Astudillo1, Gi So Lee2, Umakanth Katwa1
1Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts.
Insights
Laryngomalacia in infants can mimic other conditions. A rare neck mass compressing the airway was diagnosed after initial treatment for laryngomalacia and obstructive sleep apnea failed.
Area of Science:
- Pediatric Otolaryngology
- Neonatal Respiratory Disorders
Background:
- Laryngomalacia is a frequent cause of stridor in neonates, often managed conservatively.
- Diagnostic challenges can arise in differentiating laryngomalacia from other airway obstructions.
Observation:
- A 3-week-old infant presented with worsening noisy breathing and poor weight gain.
- Initial diagnosis of laryngomalacia and obstructive sleep apnea was made, with temporary improvement using CPAP.
Findings:
- Repeated upper airway evaluation revealed a neck mass as the cause of airway compression.
- This case highlights the importance of thorough investigation beyond initial diagnoses.
Implications:
- Accurate diagnosis of airway compression in infants is critical for appropriate management.
- Timely intervention for extrinsic airway compression significantly impacts infant prognosis.
Abstract:
Laryngomalacia is a common cause of chronic noisy breathing that can present as stridor in infants and neonates. Mild cases of laryngomalacia are usually followed clinically and managed conservatively. However, the evaluation and diagnosis could be challenging in some patients. We present a case of a 3-week-old male infant with persistent and worsening noisy breathing, snoring, and poor weight gain, prompting further evaluation. The patient had an initial diagnosis of laryngomalacia and obstructive sleep apnea with complete resolution of loud breathing with continuous positive airway pressure. A repeated evaluation of the upper airway for further investigation led to the diagnosis of a neck mass compressing the airway. We review the clinical presentation, management, and follow-up of this patient, as well as the literature of possible etiologies. In the case of our patient, timely diagnosis and treatment had significant prognostic implications.
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