(732) Congenital Vallecular Cyst: A Case Report

Introduction: Congenital vallecular cyst is one of the rare etiologies of upper airway obstruction. Clinical spectrum of presentation ranges from asymptomatic to recurrent episodes of dyspnea, stridor, choking, hoarseness, apnea, dysphagia, and life-threatening obstruction of upper airways. Due to scarcity of literature review, exact incidence is not known.

Description: A 10-month-old male, vaccinated, developmentally normal, with no comorbid, presented to ER of Aga Khan University Hospital with a h/o low-grade fever and cough for 2 days, breathing difficulty, and noisy breathing from 1 day, with no h/o flue, rash, choking, or foreign body inhalation. On examination, he was hemodynamically stable, but had stridor, signs of respiratory distress, and decreased intensity of breath sounds on left side along with bilateral wheezing. The rest of systemic examination was normal. The chest radiograph showed non-homogeneous opacity in left upper and middle zones. Hb of 8.9 g/dl, TLC counts of 13 x10 9 with neutrophils 86.1 %, lymphocytes 11, procalcitonin 2 ng / ml, and blood and tracheal aspirate cultures negative. His arterial blood gas showed mixed respiratory and metabolic acidosis. In PICU, he required high ventilatory parameters, gradually weaned off, tolerated spontaneous breathing trial and was extubated on second PICU day, but immediately developed stridor and respiratory distress and was reintubated by paeds intensivist using a MAC video laryngoscope, which showed a large cyst obstructing laryngeal inlet. The vocal cords and subglottic area appeared normal. Reevaluation by ENT consultant confirmed the diagnosis of vallecular cyst. Cyst was aspirated and cauterized by ENT team in operating room and was shifted to PICU. Analgesics, antibiotics, and dexamethasone were administered postoperatively, and next day was successfully extubated, without work of breathing or stridor. He did not require any noninvasive ventilation and was discharged home on fifth postoperative day.

Discussion: We conclude that, rare causes such as laryngeal cysts should be taken into account when a child presents with signs and symptoms of upper airway obstruction. We have also come to the conclusion that use of the C-MAC video laryngoscope contributed to diagnosis of vallecular cyst.