Impending Airway Compromise due to Cystic Hygroma

 

Author Affiliation
Giora Weiser, MD Rambam Health Care Campus, Meyer Children’s Hospital, Rambam Health Care Campus, Haifa, Israel
Nira Beck-Razi, MD Rambam Health Care Campus, Department of Medical Imaging, Haifa, Israel
Itai Shavit, MD Rambam Health Care Campus, Meyer Children’s Hospital, Rambam Health Care Campus, Haifa, Israel

ABSTRACT

We report on a 3-month-old infant, who arrived in the pediatric emergency department (ED) with a cervical cystic hygroma causing an impending compromise of the airway. We recognize that such a lesion can rapidly progress, and the judicious use of imaging in the ED may help to avoid airway compromise and possibly fatal complications.

A 3-month-old boy, who was diagnosed after birth as having a cystic hygroma, was referred to the emergency department (ED) for further evaluation. The baby had no signs of respiratory distress, but a large lesion was noticed on the right neck, emerging from the base of the tongue and threatening the airway patency (Figure 1). Ultrasound examination revealed a large cystic lesion insinuating around the normal structures of the neck on both sides without compressing the airway (Figure 2). The patient was admitted for further evaluation, and a prophylactic tracheotomy was performed. Unfortunately, the baby died at home 2 months later because of tracheotomy tube–related complications.

Figure 1. A, Cystic hygroma on the right side of the neck. B, The lesion is infiltrating the oral cavity and displacing the tongue upward.
Figure 1. A, Cystic hygroma on the right side of the neck. B, The lesion is infiltrating the oral cavity and displacing the tongue upward.
Figure 2. Sonographic longitudinal view of the right neck. A large mass is seen (arrows), insinuating around the normal structures of the neck. The mass is partially anechoic (cystic) and partially shows mixed echogenicity with septae of variable thickness.
Figure 2. Sonographic longitudinal view of the right neck. A large mass is seen (arrows), insinuating around the normal structures of the neck. The mass is partially anechoic (cystic) and partially shows mixed echogenicity with septae of variable thickness.

Footnotes

Supervising Section Editor: Sean Henderson, MD
Submission history: Submitted January 1, 2011; Revision received January 14, 2011; Accepted February 7, 2011
Reprints available through open access at http://escholarship.org/uc/uciem_westjem
DOI: 10.5811/westjem.2011.2.2170

Address for Correspondence: Itai Shavit, MD
Rambam Health Care Campus, Meyer Children’s Hospital, Department of Emergency Medicine, 6 Ha’Aliya St, PO Box 9602, Haifa 31096, Israel
E-mail: itai@pem-database.org

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources, and financial or management relationships that could be perceived as potential sources of bias. The authors disclosed none.

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