Life- threatening cause of stridor and respiratory distress in a young infant

Abstract

We would like to demonstrate the case of a 7 week old male infant (premature birth 35+3, twin-to-twin transfusion syndrome) presenting with biphasic stridor, cough, signs of dyspnea, desaturation and feeding problems. Before, the child had been admitted to another clinic and was treated with salbutamol and cortisone. Showing no signs of improvement, he was converted to our clinic. The infant was in a poor general condition on arrival with tachypnea, subcostal retractions and biphasic stridor. We performed a chest x-ray, an echocardiography and an ultrasound of the throat. The ultrasound showed hypoechoic soft tissue with prominent vessels near the larynx obstructing the upper airway. For further investigation bronchoscopy was performed showing a subglottic haemangioma nearly obstructing the entire airway. The child was intubated and on mechanical ventilation for 11 days. Immediately after bronchoscopy, a treatment with propranolol was initiated. The following bronchoscopy, 14 days after commencing propranolol treatment, showed almost normal findings. The child was discharged from the hospital after three weeks and showed no further respiratory symptoms since. Follow ups including larynx sonography every three months were always without pathological findings. The propranolol treatment ended after 12 months. Further investigation should rapidly be performed in cases of respiratory distress in an infant with uncommon symptoms, especially when showing no improvement under regular treatment. When suspecting a subglottic airway obstruction larynx sonography including colour Doppler is a safe and non-invasive diagnostic tool complementary to airway endoscopy.