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Intrathoracic cystic hygroma in an infant with respiratory failure
B N Balkaran1, P Maharaj, P Pitt-Miller
1Faculty of Medical Sciences, University of the West Indies, Trinidad.
Insights
A 6-month-old infant with bronchiolitis symptoms experienced respiratory failure due to a mediastinal cystic hygroma. Prompt endotracheal intubation and oxygen therapy rapidly resolved the respiratory distress, highlighting the importance of considering rare causes.
Area of Science:
- Pediatric Respiratory Medicine
- Thoracic Surgery
- Medical Imaging
Background:
- Bronchiolitis is a common viral illness in infants, typically affecting small airways.
- Acute respiratory failure in infants necessitates prompt diagnosis and intervention.
- Differential diagnosis for respiratory distress in infants includes various congenital and acquired conditions.
Observation:
- A 6-month-old infant initially presented with bronchiolitis symptoms.
- Despite standard bronchiolitis treatment, the infant developed severe large airway obstruction and respiratory failure.
- Clinical deterioration prompted further investigation beyond typical bronchiolitis management.
Findings:
- Endotracheal intubation and oxygen therapy led to immediate improvement in respiratory failure.
- Radiological imaging, including chest X-ray and CT scan, revealed a mediastinal mass.
- Histological examination of a surgical biopsy confirmed a cystic hygroma as the cause of airway obstruction.
Implications:
- This case underscores the importance of considering uncommon etiologies for respiratory failure in infants, even with initial presentation suggestive of common conditions like bronchiolitis.
- Mediastinal cystic hygromas, though rare, can present as a critical airway obstruction in neonates and infants.
- Multimodality imaging and biopsy are crucial for definitive diagnosis and guiding appropriate surgical or medical management.
Abstract:
A 6-month-old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment for bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.