Abstract

Laryngeal papilloma. Lateral soft tissue radiograph of the neck (Figure 2) demonstrated a posterior midtracheal bulge (closed arrow) with a normal-appearing retropharyngeal space (open double-headed arrow) and epiglottis (open arrow). During the ED course, the child became progressively more lethargic. Flexible fiberoptic nasopharyngoscopy demonstrated a mass on the left false vocal cord obstructing nearly 90% of the larynx. The patient was taken quickly to the operating room, where intubation and tracheostomy were performed. Postintubation fiberoptic bronchoscopy (Figure 3) demonstrated a fleshy mass on the left false vocal cord. The triad of relentlessly progressive hoarseness, stridor, and respiratory distress is the hallmark of recurrent respiratory papillomatosis. Although an infrequent entity, recurrent respiratory papillomatosis is one of the most common benign neoplasms of the larynx among children between 2 and 4 years of age. Human papilloma virus types 6 and 11 are the causative organisms, and transmission is vertical. It is commonly misdiagnosed as asthma, recurrent croup, or bronchitis and often is unrecognized until acute airway compromise occurs. Images in Emergency MedicineAnnals of Emergency MedicineVol. 46Issue 5PreviewA 2-year-old boy presented to the emergency department (ED) with a 1-month history of recurrent episodes of respiratory distress, noisy breathing, and hoarse voice. He had been treated multiple times for similar symptoms during the previous month, and treatment had focused on a diagnosis of reactive airway disease. Vital signs were remarkable for a respiratory rate of 40 breaths/min. Physical examination revealed an alert interactive child with nasal flaring, suprasternal and substernal retractions, and inspiratory stridor. Full-Text PDF

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