ABSTRACT
Systemic disease is an uncommon cause of subglottic stenosis (SGS). We report a case of severe SGS due to underlying eosinophilic granulomatosis with polyangiitis (EGPA) in a child presenting with isolated stridor. EGPA is a rare systemic vasculitis with very limited cases reported in the pediatric population. While surgical intervention was required given the degree of stenosis in this case, medical management of the underlying systemic disease process is critical when there is clinical suspicion of SGS in the context of systemic vasculitis. Laryngoscope, 131:656-659, 2021.
Subject(s)
Eosinophilic Granuloma/complications , Granulomatosis with Polyangiitis/complications , Laryngostenosis/etiology , Tracheal Stenosis/etiology , Child, Preschool , Glottis/pathology , Humans , Male , Respiratory Sounds/etiologyABSTRACT
OBJECTIVE: To determine the accuracy of histopathologic diagnosis in distinguishing eosinophilic esophagitis (EE) from gastroesophageal reflux disease (GERD) in children with upper aerodigestive symptoms. DESIGN: Masked review of esophageal biopsy findings and comparison with each child's established clinical diagnosis. SETTING: A tertiary care multidisciplinary aerodigestive center. PATIENTS: Children were selected from a longitudinal database of all children referred for upper aerodigestive symptoms who underwent a comprehensive evaluation between September 1, 2004, and September 1, 2007. Three groups were recognized based on clinical presentation, initial histologic review, and therapeutic response: children with EE, GERD, or neither. INTERVENTION: Review of esophageal biopsy findings by a pathologist masked to the child's clinical or previous pathologic diagnosis. MAIN OUTCOME MEASURE: Masked histopathologic diagnosis of EE, GERD, or neither. RESULTS: Medical records from 31 patients were reviewed (11 children with EE, 10 with GERD, and 10 with neither). Diagnostic concurrence between the masked pathologic diagnosis and the established clinicopathologic diagnosis was 64% in children with EE, 70% in children with GERD, and 100% in children with neither. The 4 cases of EE that did not concur were misclassified as GERD when esophageal specimens were evaluated by histopathologic means alone. A clinicopathologic schema for EE developed by gastroenterologists accurately identified 82% of children with EE. CONCLUSIONS: The distinction between EE and GERD cannot be reliably made on histopathologic evidence alone in children with upper aerodigestive symptoms. Despite the recent gastroenterology consensus statement regarding the clinicopathologic diagnosis of EE, children with primary airway symptoms in whom EE is suspected represent a diagnostic dilemma.
Subject(s)
Eosinophilia/diagnosis , Eosinophilia/epidemiology , Esophagitis/diagnosis , Esophagitis/epidemiology , Biopsy , Child, Preschool , Cough/epidemiology , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Diagnosis, Differential , Esophagoscopy , Esophagus/pathology , Female , Gastroesophageal Reflux/diagnosis , Humans , Male , Respiratory SoundsABSTRACT
OBJECTIVES: To report our experience with all patients diagnosed with type 1 laryngeal cleft over a period of 3 years in our referral practice and to describe a functional diagnostic and management algorithm for children with this disorder. METHODS: A prospective longitudinal study in a tertiary care referral center. Twenty pediatric patients diagnosed with type 1 laryngeal cleft in a 3-year period (5/1/2002-5/1/2005) were included in this study. The incidence, presenting symptoms, diagnostic procedures, medical and surgical interventions performed, and clinical outcomes were evaluated. RESULTS: The incidence of type 1 laryngeal cleft was 7.6%. Among the 20 patients in this study, aspiration with thin liquids was the most common presenting symptom (18 patients, 90%). Three patients underwent modified barium swallow (MBS) alone, 3 patients underwent functional endoscopic evaluation of swallow (FEES) alone, and 11 patients underwent both MBS and FEES prior to intraoperative endoscopic evaluation. Four patients (20%) were successfully treated with conservative therapy. Sixteen patients (80%) required endoscopic surgical repair after failing a course of conservative measures. The success rate of surgical repair was 94% (15 out of 16 patients). CONCLUSIONS: Type 1 laryngeal cleft can be challenging diagnostically. We propose a functional diagnostic and management algorithm that includes MBS, FEES, suspension laryngoscopy with bimanual interarytenoid palpation, and a trial of conservative therapy, as a way to diagnose and manage type 1 laryngeal cleft prior to consideration of surgical repair. If conservative therapy fails, then surgical intervention is indicated.
Subject(s)
Algorithms , Larynx/abnormalities , Trachea/abnormalities , Child, Preschool , Congenital Abnormalities/diagnosis , Deglutition Disorders/congenital , Deglutition Disorders/diagnosis , Deglutition Disorders/physiopathology , Deglutition Disorders/therapy , Endoscopy , Esophagus/abnormalities , Esophagus/physiopathology , Female , Humans , Incidence , Infant , Larynx/physiopathology , Larynx/surgery , Male , Prospective Studies , Trachea/physiopathology , Trachea/surgery , Treatment OutcomeABSTRACT
The stability of the shape of a solid cylinder crystallizing in a supercooled liquid is treated. The effects of solute diffusion, slightly anisotropic surface tension and interface kinetics are included. The resulting stability equations are applied to the specific case of ice cylinders.
