Introduction Case Report Discussion. References ...
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Vallecular cyst : A rare cause of Respiratory Distress and Stridor in. New Born. Saurabh Patel M.D.. 1. , Ankita Shukla, M.D.. 1. , Shardha Polam, M.D.. 1,2.
Vallecular cyst : A rare cause of Respiratory Distress and Stridor in New Born. 1 M.D. ,
1 M.D.
1,2 M.D.
Saurabh Patel Ankita Shukla, , Shardha Polam, 1 Department of Pediatrics , The Children’s Hospital at Saint Peter’s University Hospital, 2 Drexel University College of Medicine , New Brunswick, NJ
Introduction
Case Report
.
A Vallecular cyst (VC) is a rare cause of stridor with or without respiratory distress in infants more commonly seen in adults Also known as retention cyst, epiglottic cyst, ductal cyst and base of tongue cyst. Increased risk of sudden respiratory distress and death May present from 1st week to 16th week of life
Radiology
41 week female infant 25 y ear old G1P0 ,NSVD, , B+/B+ maternal serologies negative APGAR scores of 5 & 7 at age 1 & 5 mins Meconium stained AF Born apneic, and floppy at birth
Required intubation and suction below cords x 2 Transferred to ICN on ventillator Surfactant given X 1. ECHO obtained and infant started on pressor support d/t depressed cardiac funtion
CXR- small pneumothorax and pneumomediastinum- resolved without intervention Weaned gradually from ventilator on DOL 4 MRI brain/neck obtained for continued respiratory distress and increased FiO2 requirement- VALLECULAR CYST found as an incidental finding
ENT consulted. Pt tatken to OR and malsupialisation done. Respiratory Distress resolved. Fig 1 : sagital and coronal section depicting the vallecular cyst at the level of C2-C3
Discussion. VALLECULAR CYST can be fatal when associated with sudden airway obstruction Cyst forms as a consequence of either ductal obstruction of 1 mucous glands and or an embryological malformation . Bimodal age of presentation. Three major categories (based on adult observation): Ductal cysts (most common type) Thyroid cartilage foraminal cyst Saccular cysts Newborns can present with:2 Stridor Hoarse cry Feeding problems Chest retraction Apnea/cyanosis Failure to thrive Histology: contains respiratory epithelium with mucous glands. Diagnosis: Antenatal ultrasound and fetal MRI. Awake flexible laryngoscopy. Lateral X-ray of neck- difficult to interpret, but may be helpful. Treatment: Cyst Marsupialisation
References. Gutierrez JP, Berkowitz RG, Roberson CF. Vallecular cyst in Newborns and young infants.Pediatric Pulmonology 27:282-285 (1999). Hsieh WS, Yang PH, Wong KS, Li HY, Wang ECR, Yeh TF. Vallecular cyst: an uncommon cause of stridor in newborn infants. European Journal of Pediatrics. 159:79-81 (2000).
