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Infected Thyroglossal Duct Cyst in a Neonate: A Report of a Rare Case
Brandon Tapasak1, Dang-Khoa Nguyen1, Sergio S Cervantes1,2
1Department of Medical Education, University of Central Florida College of Medicine, Orlando, FL, USA.
Insights
This case report details a rare instance of an infected thyroglossal duct cyst in a neonate presenting with upper airway obstruction. Early diagnosis and intervention are crucial for managing this uncommon pediatric condition.
Area of Science:
- Pediatric surgery
- Congenital anomalies
- Neonatal care
Background:
- Thyroglossal duct cysts are common congenital cervical anomalies, typically presenting as midline neck masses in children aged 5-9 years.
- Neonatal presentation is rare, with infection and upper airway obstruction being uncommon sequelae.
Observation:
- A 3-week-old neonate presented with acute upper airway obstruction due to an infected thyroglossal duct cyst.
- The cyst caused significant tongue displacement and supraglottic edema, complicating intubation.
- Methicillin-sensitive Staphylococcus aureus was identified as the causative agent.
Findings:
- Infected thyroglossal duct cysts can manifest as emergent upper airway obstruction in neonates.
- Prompt incision and drainage, followed by antibiotic treatment, are essential for initial management.
- Successful surgical excision via Sistrunk procedure was achieved 6 months post-drainage.
Implications:
- Highlights the importance of considering thyroglossal duct cysts in neonatal airway emergencies.
- Underscores the need for prompt diagnosis and management of infected congenital neck masses.
- Provides insights into the rare presentation and treatment of neonatal thyroglossal duct cysts.
Abstract:
BACKGROUND Thyroglossal duct cysts are the most common congenital cervical anomalies, often presenting as midline neck cysts. The mean age of presentation of pediatric thyroglossal duct cysts varies between 5 and 9 years old, with rare cases younger than 1 year old. This case report details a rare case of an infected thyroglossal duct cyst presenting during the neonatal period as an upper airway obstruction. CASE REPORT A 3-week-old neonate born full-term with no complications during pregnancy or labor presented with a 5-day history of worsening nasal congestion and upper airway obstruction after an upper respiratory infection. Physical examination revealed a large midline neck mass measuring 3.1×4.2×3.2 cm abutting the hyoid with internal echogenicity consistent with a thyroglossal duct cyst, causing posterior tongue compression of the airway and airway distress. The patient was emergently taken to the operating room for incision and drainage, where she underwent a difficult intubation due to superior-posterior tongue displacement and global supraglottic edema. She was discharged on postoperative day 5 on a course of Augmentin after cultures grew methicillin-sensitive Staphylococcus aureus. The patient had no further complications, with successful excision using a Sistrunk procedure 6 months later. CONCLUSIONS Pediatric thyroglossal duct cysts most often present as an asymptomatic midline neck mass, with rare sequelae of infection and upper airway obstruction. This case report highlights the pathophysiology and presenting symptomology of thyroglossal duct cysts, explores the rarity of infected thyroglossal duct cysts in neonates, and reviews the current literature on management strategies for these patients.
