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A 1-year 5-month-old boy presents with a 1-day history of severe biphasic stridor. He had multiple previous admissions for recurrent lower respiratory tract infections. On his last admission, a month earlier, he was seen for noisy breathing, where laryngomalacia was suspected and confirmed on non

Shortness of breath and wheezing are common presenting signs for children in the emergency department. In adolescence, it is often due to asthma or lower respiratory tract infections. We present a rare pediatric case of an adolescent with biphasic stridor and progressive exercise-induced shortness of breath who was found to have severe idiopathic subglottic stenosis.

Congenital vallecular cyst (VC) is a rare but potentially fatal pathology in neonates and infants. It usually manifests with symptoms such as stridor, apnea and cyanosis that develop shortly after birth. Stridor is the most common encountered symptom. VC is frequently accompanied by laryngomalacia (LM) and LM is the most common cause of stridor in infants. Diagnosis can be made by flexible laryngoscopy or bronchoscopy. Surgery is the mainstay for VC treatment. Here we present an infant who had respiratory distress, biphasic stridor and cyanosis worsened during feeding and crying, and diagnosed VC. The respiratory symptoms of the patient recovered rapidly after surgical resection.

Dyspnea is a common presentation in upper and lower airway obstructive causes. However, biphasic stridor and hoarseness should prompt evaluation of the upper airway. Nasendoscopy carried out by the otolaryngology team is a quick and an effective way of evaluating the upper airway.

Infantile subglottic hemangioma (SH) can cause biphasic stridor, respiratory distress and even life-threatening airway compromise. Treatment of SH in infants has traditionally been characterized as a challenging situation with multiple therapeutic options without consensus as to which one is the best and with risks of severe side-effects. Four infants with SH were treated with propranolol. Treatment with oral propranolol resulted in resolution of symptoms within 2 days, followed by complete recovery. Propranolol appears to be an effective treatment for SH and should be used as a first-line treatment for SH when intervention is required.

We describe the case of a child with isolated absence of cartilaginous tracheal rings and a trifurcate carina. At 6 months of age, the patient presented to our multidisciplinary airway clinic with stridor and recurrent severe respiratory infections requiring hospitalization. Radiographs showed airway narrowing. Exam demonstrated biphasic stridor. Flexible fiberoptic laryngoscopy demonstrated only mild laryngomalacia. Operative bronchoscopy demonstrated severe tracheomalacia with absence of any visible tracheal rings and a trifurcate carina. Subsequent CT imaging corroborated these findings and did not demonstrate any other major abnormality. The patient did not require operative intervention and his subsequent course was uncomplicated.

The management of airway obstruction in children is often challenging with acute presentation and uncertainty in the diagnosis. We report a case of a young child with acute onset biphasic stridor who was found to have a large subglottic lesion causing significant airway obstruction. We were able to successfully resect it to achieve a pathologic diagnosis and address the subglottic stenosis with an anterior laryngofissure followed by laryngotracheal reconstruction (LTR) using a rib graft. The final pathology was diffuse large B-cell lymphoma, anaplastic variant, and patient had complete response to chemotherapy and is currently free of disease.

The use of propranolol for the treatment of subglottic haemangioma has become hugely popular due to its effectiveness and safety profile. We report a case of 7-month-old boy who presented with stridor and histopathology suggestive of subglottic haemangioma following microlaryngoscopy and bronchoscopy (MLB). However, he did not respond to propranolol treatment. This could be due to an older age of propranolol commencement. In general, early commencement of propranolol is necessary when diagnosis of symptomatic infantile haemangioma is made to achieve maximal improvement in symptoms and prevent further proliferation. There should be a high index of suspicion for subglottic haemangioma in children presenting with chronic biphasic stridor, with early MLB and diagnosis. This will allow early treatment, giving the best chance to avoid our situation.

A 56-year-old female with a background of metastatic rectal adenocarcinoma presented with a subglottic mass causing biphasic stridor. Transoral laser microsurgery and the use of fibrin glue prevented the need for tracheostomy. Six months postoperatively there was no evidence of recurrence. Laryngeal metastasis of colorectal adenocarcinoma, although remarkably rare, is perhaps more prevalent than commonly perceived and the presence of laryngeal symptoms in a patient with colorectal adenocarcinoma should raise concern. This case is presented to aid physicians should they encounter a similar presentation of metastasis to the subglottis.

An 80 year old woman presented to the emergency department with increasing shortness of breath on exertion and “noisy breathing.” She was easily able to complete full sentences, but on examination there was a faint biphasic stridor. The patient stated that she had been breathing like this for months but that it was slowly worsening. She had no polyphonic expiratory wheeze and on …

Hyper Immunoglobulin E Syndrome, or Job's Syndrome, is a rare multisystem disorder that classically presents in early childhood with a triad of clinical manifestations that include severe eczematous dermatitis, recurrent infections (skin and lung), and elevated serum immunoglobulin E. Hyper Immunoglobulin E Syndrome is a relatively uncommon condition and as such requires careful consideration of a constellation of patient symptoms to correctly diagnose the underlying disease. In this report we present a unique case of a child with previously undiagnosed Hyper Immunoglobulin E Syndrome presenting with biphasic stridor associated with multiple areas of tracheal stenosis.

OBJECTIVE This study aimed to highlight the pitfalls of relying on radiographs in identifying potentially life-threatening upper airway foreign bodies in children. DESIGN Case series. METHODS A review of the medical records of 2 cases of upper tracheal foreign body was performed. RESULTS Both patients presented with biphasic stridor refractory to medical therapy and chest radiographs that were normal. One patient had a history of witnessed aspiration while the other did not. Both patients were managed by endoscopic removal of foreign bodies in the operating room and experienced no long-term sequelae related to this event. CONCLUSIONS Tracheal foreign bodies present a diagnostic challenge, and patients may fail to manifest radiographic abnormalities. In patients with a characteristic history and biphasic stridor, an endoscopic evaluation of the airway should be performed to avoid potentially devastating consequences.

Purpose : To illustrate the challenge and approach to diagnosing a laryngeal foreign body (FB) in a child with pre-existing laryngeal pathology. Methods : Case report. The diagnosis of laryngeal FB was initially missed in a 21-month old-infant. Two weeks later, the child experienced worsening in symptoms. Results : Flexible laryngoscopy revealed the presence of a plastic object in the subglottis, which was then removed under general anesthesia. Conclusions : For children with pre-existing laryngeal pathology, a sudden unexplained worsening of laryngeal symptoms, particularly dysphonia and biphasic stridor, should prompt the clinician to consider the possibility of a thin, sharp laryngeal FB.

WOS: 000335934100028 PubMed: 24602457 Subglottic hemangioma is a rare but life- threatening condition which requires intervention. It generally starts proliferating in the first and second months of lifespan and whether there is a respiration problem or not, it causes biphasic stridor. Its diagnosis generally requires direct laryngoscopy or direct screening through bronchoscopy. This case report presents a 45-day-old girl who had subglottic hemangioma presenting with wheezing and stridor. Our case took propranolol with a dose of 2 mg/kg/day and within 48 h after the start of the treatment, obstructive symptoms started to alleviate considerably. (C) 2014 Elsevier Inc. All rights reserved.

Tracheal malformations consist of a variety of anomalies related to abnormal development of the tracheobronchial tree. The most common clinical findings associated with tracheal narrowing include biphasic stridor with a prolonged expiratory component and cough that can be wet or bronchial in nature (from retained secretions). This chapter focuses on tracheomalacia, tracheal stenosis, tracheoesophageal fistula, tracheal bronchus, and bronchogenic cysts.

Imagine you are asked to evaluate the airway of a 4 months old with noisy breathing. Surrounded by anxious parents and helpless staff, you find an emaciated infant with biphasic stridor and suprasternal and subcostal retractions. He has been feeding poorly and intermittently cyanotic for several days. The first thing you must remember not to do is panic. The critical airway can be safely and effectively managed when a composed surgeon follows a sensible thought process and conducts a directed work up as part of a multidisciplinary care team.

Department of Otorhinolaryngology Head and Neck Surgery, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA b Section of Pediatric Surgery, Mayo Clinic and Mayo Eugenio Litta Children’s Hospital, Rochester, MN, USA Division of Pediatric Radiology, Mayo Clinic and Mayo Eugenio Litta Children’s Hospital, Rochester, MN, USA Division of Pediatric Otolaryngology, Mayo Clinic and Mayo Eugenio Litta Children’s Hospital, Rochester, MN, USA

Patients with subglottic hemangioma present with biphasic stridor during infancy. The natural history of this lesion is characterized by progressive airway obstruction during the proliferative phase of the lesion, followed by resolution of symptoms during the subsequent involutive phase. Although this is a benign neoplasm, it can be associated with a fatal outcome. Treatment options have been directed at maintaining airway patency during the proliferative phase. The senior author (G.B.H.) originally described the role of the carbon dioxide laser in management of these patients in 1980. Thirty-one patients were treated for subglottic hemangioma at The Children's Hospital, Boston, between 1980 and 1990. The 10-year experience of management of subglottic hemangioma with endoscopic vaporization using the carbon dioxide laser is reviewed to assess the efficacy of this technique.