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Thymic cyst haemorrhages and transient cholestasis in a 4-week-old infant
L P Koopman1, F B Plötz, J J Meuzelaar
1Department of Paediatrics, University Hospital Groningen, The Netherlands.
Insights
Massive hemorrhages in infant thymic cysts caused respiratory distress, requiring surgery. This case highlights thymic cysts as a potential cause of infant respiratory issues, even with vitamin K prophylaxis.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Pathology
Background:
- Multilocular thymic cysts are rare in infants.
- Respiratory distress in neonates necessitates prompt diagnosis and intervention.
Observation:
- A 4-week-old infant presented with acute respiratory distress.
- Imaging revealed massive hemorrhages within multiple thymic cysts causing tracheal obstruction.
Findings:
- Surgical intervention (right hemithymectomy) relieved the obstruction.
- Hemorrhages were suspected to be due to vitamin K deficiency despite prophylaxis.
- Transient cholestasis occurred, possibly related to bilirubin buildup from cyst hemorrhages.
Implications:
- This case underscores thymic cysts with hemorrhage as a critical cause of neonatal respiratory distress.
- It suggests a potential link between vitamin K deficiency, thymic hemorrhages, and cholestasis in infants.
- Early surgical management can lead to favorable outcomes in such cases.
Unlabelled:
We report a 4-week-old boy with acute respiratory distress, due to massive haemorrhages in multiple thymic cysts. A right hemithymectomy was performed because of mechanical obstruction of the trachea by the cysts. The origin of the multilocular thymic cysts remained unclear. Most likely, these haemorrhages were caused by vitamin K deficiency, although the infant received vitamin K prophylaxis. In addition, he developed transient cholestasis, but the aetiology remained unclear. It is postulated that massive haemorrhages in thymic cysts produce large amounts of bilirubin, causing sludging of bile excretions in the liver. Four weeks after the operation, all laboratory findings were normal and 6 months after the operation the boy is still healthy.
Conclusion:
This case report shows that respiratory distress in an infant can be caused by multiple haemorrhages in multilocular thymic cysts.