When Stridor is Not Croup: A Case Report.

BACKGROUND: Croup is one of the most common causes of acute respiratory disorder in children. It presents as acute laryngeal symptoms in the context of viral infection. Treatment consists of systemic steroids and aerosolized adrenaline, after which the symptoms must resolve rapidly. There are many differential diagnoses, including neurological causes. In these cases, clinical presentation is atypical and the outcome can be less favorable. CASE REPORT: We present the cases of three children who presented with stridor, which was initially treated as croup but eventually turned out to have a neurological origin. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Clinicians need to be aware of the differential diagnoses of croup. We suggest a few key points to help emergency physicians manage these patients, including adequate use of monitoring and nasofibroscopy. Early identification is a key element in the effective management of certain rapidly progressive neurological diseases.

[Upper Airway Obstruction in a Type 4 Laryngeal Palmar in Infant]. / Obstruction des Voies Aeriennes Superieures dans une Palmure Laryngee de Type 4 Chez le Nourrisson.

INTRODUCTION: Congenital malformations of the larynx in children are often manifested by laryngeal noise (stridor), dyspnea, dysphonia and sometimes swallowing disorders. Laryngomalacia is the most common anomaly, but it is necessary to know how to look for laryngeal paralysis, congenital subglottic stenosis, sometimes a subglottic angioma or a laryngeal diastema. Endoscopy is the master examination for confirming the diagnosis and guiding the management, which may be medical and/or surgical depending on the case [1]. OBJECTIVE: Aim: The aim of our work is to study the diagnostic and therapeutic particularities of a congenital malformation in an infant in a context of insufficient materials. OBSERVATION: We report an observation of an infant aged 06 months, who was referred to us from pediatrics for chronic dyspnea with dysphonia dating back to birth without other congenital anomalies after multiple treatments without improvement based on nebulization, corticoids and antibiotics. Nasofibroscopy revealed a laryngeal web-like larynx connecting the two vocal cords on its anterior two-thirds leaving a small respiratory tract (Figure 1). The diagnosis of laryngeal palmaris was retained. Management consisted of resection during panendoscopy. Nasofibroscopy at regular intervals of up to twelve months were performed without particularity. CONCLUSION: Dyspnea in infants can be frequent and have many causes. Only a thorough clinical and paraclinical examination can help to diagnose laryngeal palmaris. They are confusing to all laryngeal malformations. The prognosis can be serious if management is not carried out as soon as possible.

INTRODUCTION: Les malformations congénitales du larynx de l'enfant se manifestent souvent par un bruit laryngé (stridor), une dyspnée, une dysphonie et parfois des troubles de la déglutition. La laryngomalacie est l'anomalie la plus fréquente, mais il faut savoir rechercher notamment une paralysie laryngée, une sténose sous-glottique congénitale, parfois un angiome sous-glottique ou un diastème laryngé. L'endoscopie est le maître-examen pour confirmer le diagnostic et orienter la prise en charge qui peut être médicale et/ou chirurgicale suivant les cas [1]. OBJECTIF: Le but de notre travail est d'étudier les particularités diagnostiques et thérapeutiques d'une malformation congénitale chez un nourrisson dans un contexte de matériel insuffisant. OBSERVATION: Nous rapportons une observation d'un nourrisson âgé de 06 mois, qui nous a été référé de la pédiatrie pour dyspnée chronique avecdysphonie remontant à la naissance sans autres anomalies congénitales après de multiples traitements sans amélioration à base de nébulisation, corticoïdes et antibiotiques.La nasofibroscopie mettait en évidence un larynx d'aspect de palmure laryngée reliant les deux cordes vocales sur ses deux tiers antérieurs laissant une petite filière respiratoire (Figure 1). Le diagnostic de palmure laryngée a été retenu. La prise en charge a consisté en une résectionlors de la panendoscopie. Des nasofibroscopiesà intervalle régulier jusqu'à douze mois furent réalisées sans particularité. CONCLUSION: Lesdyspnées chez le nourrisson peuvent êtrefréquentes et avoir beaucoup de cause. Seul un examen clinique et paraclinique poussé peut aider à diagnostiquer la palmure laryngée. Ils prêtent à confusion a toutes les malformations laryngées.Le pronostic peut être grave si la prise en charge n'est pas effectué dans les meilleurs délais.

Melanoma nasofaríngeo: caso clínico

Resumen El melanoma mucoso primario (MM) de la cavidad nasal y los senos paranasales sigue siendo un tumor maligno poco frecuente. El pico de incidencia se sitúa entre 50 y 60 años, siendo la epistaxis y la obstrucción nasal unilateral los síntomas más frecuentes. La resección quirúrgica es el tratamiento primario con radioterapia y quimioterapia adyuvante si es necesario, el pronóstico depende de la extensión. Presentamos el caso de una paciente mujer de 81 años con hemoptisis y halitosis de un año de evolución. La nasofibrolaringoscopia mostró una lesión parduzca, excrecente, irregular y friable, en el borde derecho del rodete tubárico derecho. El resultado histopatológico fue MM nasofaríngeo. Perfil inmunohistoquímico: S100 +, MelanA +, HMB45 +, SOX10 +, AE1AE3 negativo. El PET-CT mostró una hipercaptación a nivel del rodete tubárico derecho, sin evidencia de adenopatías o metástasis a distancia. Se realizó la resección tumoral completa mediante abordaje endoscópico. El Comité de Oncología del Melanoma decidió que no era necesario un tratamiento adyuvante debido a la resección completa de la lesión y considerando la edad y el deterioro cognitivo de la paciente.

Abstract Primary mucous melanoma (MM) of the nasal cavity and paranasal sinuses remains a rare malignancy. The peak of incidence is between 50 and 60 years old, being epistaxis and unilateral nasal obstruction the most frequent symptoms. Surgical resection is the primary treatment with radiotherapy and adjuvant chemotherapy if necessary, the prognosis depends on the spreading. We present the case of an 81-year-old female patient attending for hemoptysis and halitosis of a year of evolution. The nasofibrolaryngoscopy showed a brownish, excrescent, irregular and friable lesion, outgrowth of the right tube rim. Histopathology result was nasopharyngeal MM. Immunohistochemical profile: S100 +, MelanA +, HMB45 +, SOX10 +, AE1AE3 negative. PET-CT showed a hypercaptation at the level of the right tube rim, without evidence of adenopathies or distant metastases. Complete tumor resection was performed by endoscopic surgery. Melanoma Oncology Committee decided no need of adjuvant therapy due to the complete resection of the lesion and considering the age and cognitive deterioration of the patient.

[Dyspnoea revealing laryngopyocele]. / Une dyspnée révélant une laryngopyocèle.

Laryngocele is rare; it is an abnormal dilatation of the laryngeal appendix or of the Morgagni's ventricular pouch. Its size is variable. When it is small, it is usually asymptomatic. When it is large, it can manifest as a cervical anterolateral paralaryngeal mass. Diagnosis is based on CT scan. Treatment approach is still discussed. Endoscopic CO2 laser treatment has aroused great interest in recent years. We here report the clinical observation of a 24-year old woman with a 4-year history of intermittent dyspnea. Endoscopic examination showed an increase in the bulge of the right ventricular band associated with arytenoid oedema. Cervical CT scan with contrast medium objectified well-defined, hypodense collection next to the right thyroid cartilage, contrast enhanced in the periphery without bone lysis or lysis of the cartilage. It pressed the vallecula left with discreet infiltration of the surrounding grease. The diagnosis of internal laryngopyocele was suspected, confirming the clinical data. The patient was treated with antibiotics and corticosteroids before cervicotomy since it was not possible to perform endoscopic marsupialisation due to non-availability of the laser.

Fishbones in the Upper Aerodigestive Tract: A Review of 24 Cases of Adult Patients.

INTRODUCTION: We present a retrospective study series and discussion of the current literature to discuss the management of fishbones in the upper aerodigestive tract. MATERIALS AND METHODS: From January 2013 to July 2016, all patients referred to our referral center because of a fishbone in the upper aerodigestive tract were analysed. RESULTS: Of the 24 patients, 95% of them reported discomfort in the throat. It was noted that 58% of physical examinations and nasofibroscopy results were normal. Ten fishbones were found in the upper aerodigestive tract. They were removed by foreign body forceps or by endoscopy depending on the location. Foreign body-related complications were not observed. Ten patients with no identifiable fishbone had no symptoms after 48 hours. Other patients, including the 10 patients with the fishbone removed, were asymptomatic after 10 days. CONCLUSION: From our experience, we recommend a systematic nasofibroscopy. If it is normal, the patient is assessed at 48h. The complementary investigation by CT scan and/or oesophagoscopy must be reserved in cases of suspicion of oesophageal localization or complication. Otherwise, rigid or flexible endoscopy may be performed when laryngoscopy is unsuccessful or for the treatment of foreign bodies lodged below this area.

Avaliação do efeito da expansão rápida da maxila na via aérea superior, por meio da nasofibroscopia: descrição da técnica e relato de caso / Evaluation of the effect of rapid maxillary expansion on the upper airway using nasofibroscopy: case report and description of the technique

A finalidade deste artigo é avaliar o efeito da expansão rápida da maxila (ERM) na via aérea superior. Por intermédio de um caso clínico, será relatado como indivíduos com atresia da maxila e com comprometimento da função naso-respiratória podem beneficiar-se com a ERM. Para entender melhor as alterações morfológicas decorrentes do paciente com problemas respiratórios, deve-se conhecer a anatomia e a fisiologia do sistema respiratório. Entretanto, não se pode esquecer que o tratamento deste paciente é multidisciplinar, envolvendo o ortodontista, otorrinolaringologista e a fonoaudióloga.

The aim of the present investigation is to evaluate the effect of rapid maxillary expansion (RME) on the upper airway. A clinical case is presented to describe how patients with atresic maxilla and reduced naso-respiratory function can have benefits from rapid maxillary expansion. In order to better understand the morphological alterations present in patients with respiratory disorders, it is necessary to understand the respiratory system's anatomy and physiology. However, it is relevant to mention that this patient undergoes a multidisciplinary treatment, involving the orthodontist, the otorhinolaryngologist and the phonoaudiologist.

Hematoma masivo esofágico con compromiso supraglótico: reporte de un caso y revisión de la literatura / Massive esophageal hematoma with supraglottic extension: report of a case and review of the literature

Se presenta el caso de un paciente de 67 años de sexo masculino, hipertenso, diabético y usuario de aspirina en dosis anticoagulante, que consulta en el servicio de urgencia por un cuadro de inicio súbito de dolor retroesternal asociado a disnea severa y estridor. La evaluación mediante nasofibroscopfa muestra una gran masa supraglótica que obstruye el 80 por ciento del lumen, compatible con una masa esofágica. La tomograffa computarizada de tórax muestra una imagen compatible con un hematoma disecante esofágico de gran extensión, desde laringe hasta la unión gastroesofágica. El paciente se maneja en forma conservadora mediante observación, analgesia y alimentación párenteral. Se evalúa en forma periódica con tomograffa computarizada y nasofibroscopfa. Evoluciona con reabsorción progresiva del hematoma y disminución del compromiso laríngeo por lo que es dado de alta a los 10 días. Este caso ejemplifica una rara patología que además tiene una forma atípica de presentación, con obstrucción laríngea.

We present a case of a 67 years old hipertense and diabetic male. The patient refered a sudden onset of chest pain associated with severe dysnea and audible stridor. Nasofibroscopy showed a supraglottic mass that obstructed an estimated 80 percent of normal lumen, suggestive of an esophageal mass. Thorax CT scan revealed an ¡mage of a dissecting esophageal haematoma that compromised most of the esophageal extension, beggining at the laryngeal plane. The patient was managed by conservative means, through observation, analgesia and parenteral nutrition. Close follow up, by CT Scan as well as nasofibroscopy. The patient evolved well, with haematoma reabsorption and decrease of laryngeal obstruction being discharged after 10 days of hospitalization. We report a rare entity that presented in an unusual way.