Airway obstruction after anesthesia in a 3-month-old baby with lymphangioma

Abstract

Lymphangiomas are commonly benign. However, in rare cases, it may enlarge and cause airway obstruction. The objective of this clinical case report is to highlight the appropriate course of action in cases of airway obstruction. A 3-month-old boy presented with progressive inspiratory stridor since birth. Computed tomography of the thorax revealed multiple lesions on the bilateral neck, right supraclavicular and right supra-anterior to superior mediastinum. The patient was scheduled for tumor resection and injection of sclerosing agent. Induction was done using sevoflurane, and intubation was carried out and presented without complications. The operation was uneventful. After extubation, retraction in the suprasternal, intercostal, and epigastrium was observed; hence, the patient was reintubated. Extubation was then done the following day after careful positioning in intensive care. In this case, laryngeal edema was caused by the obstruction of the lymphatic drainage, which was present since before the intubation. However, after the surgery, there was worsening of the edema. It may be caused by inflammatory response toward lymphatic drainage, thus worsening lymphatic outflow obstruction.