MORE THAN A TICKLE IN THE THROAT: A CASE OF COUGH-INDUCED LARYNGEAL FRACTURE

Abstract

SESSION TITLE: Tuesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/22/2019 01:00 PM - 02:00 PM INTRODUCTION: Non-traumatic rupture of the larynx is a very rare entity occurring when strong coughing or sneezing causes rupture of the laryngeal cartilage. This same pathology is more commonly seen in traumatic injuries, particularly with hanging or strangulation victims, but non-traumatic presentations are exceedingly rare. We present the fifth case reported in the literature. CASE PRESENTATION: A 48-year-old male travelling from Brazil presented to our emergency department (ED) with complaints of neck swelling. His past medical history is significant for gastroesophageal reflux disease (GERD) and asthma. He had a recent worsening in his GERD symptoms when he was changed from daily Esomeprazole to Ranitidine, precipitating complaints of increased heartburn and a dry cough. On the day of the presentation, the patient began to experience further worsening cough as well as neck swelling. In the ED, vital signs were normal, mild swelling was noticed over the thyroid cartilage with subtle crepitus. There was no tenderness or hoarseness. Neck X-ray showed thickening of the anterior neck space. Neck computed tomography (CT) without contrast demonstrated a minimally displaced fractures of the thyroid cartilage (Image A) with overlying soft tissue edema and subcutaneous emphysema extending distally (Image B). Swallowing evaluation and esophagram were normal. The patient was observed on the medical ward for two days where he clinically improved and was discharged home on Esomeprazole. The patient was lost to follow up when he returned to Brazil. DISCUSSION: Review of the four published cases of non-traumatic rupture of the larynx in the literature reveal that all of the cases have been in middle aged men. Two cases were associated with sneezing and two were associated with coughing. Clinical presentations were with complaints of odynophagia, dysphagia and/or dysphonia. In all cases, imaging revealed anterior fractures associated with subcutaneous emphysema. Our patient shared all of these demographic and imaging characteristics, however our patient presented with a chief complaint of neck swelling without these other complaints. Management of these cases is conservative, typically with spontaneous resolution not requiring surgical intervention. CONCLUSIONS: Non-traumatic laryngeal fracture is a very rare entity, typically occurring in middle age men, induced by severe coughing or sneezing. Reference #1: Fenig, M, et al. Laryngeal fracture after coughing. The American Journal of Emergency Medicine. 31 (2013) 1421.e1–1421.e3 DISCLOSURES: No relevant relationships by Keith Rose, source=Web Response No relevant relationships by Bertin Salguero, source=Web Response No relevant relationships by Jonathan Stoever, source=Web Response