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Stephanie L Kahntroff

Division of Pediatric Anesthesiology, University of Maryland United States

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Subglottic Cysts in a Premature Infant: A Rare Complication of Prolonged Intubation

Katelyn Scharf; * Stephanie L Kahntroff; Stephanie E Jones;
  • Katelyn Scharf: Resident, Department Anesthesiology, University of Maryland School of Medicine, MD 21201, United States.
  • * Stephanie L Kahntroff: Assistant Professor, Division of Pediatric Anesthesiology, University of Maryland School of Medicine, MD 21201, United States.
  • Stephanie E Jones: Assistant Professor, Division of Pediatric Anesthesiology, University of Maryland School of Medicine, MD 21201, United States.
  • Mar 16, 2022 |
  • Volume: 3 |
  • Issue: 3 |
  • Views: 259 |
  • Downloads: 264
  • Download PDF

Abstract

Subglottic cysts are a rare cause of respiratory distress in infants. The primary risk factors for subglottic cyst formation are prematurity, low birth weight, and prolonged intubation. Therefore, early recognition and treatment are essential to prevent potentially fatal airway obstruction.

Case Presentation

A former 24-week, 640 grams premature female infant presented at ten months for evaluation of stridor. She was intubated at delivery with a 2.5 uncuffed endotracheal tube and remained intubated for more than 40 days. Her stridor developed around eight months worsened with agitation and supine positioning and improved sitting. Subglottic pathology was suspected, including stenosis, edema, or cysts.

Operative evaluation using tracheobronchoscopy was performed. Total intravenous anesthesia, topicalization of the vocal cords, and spontaneous respirations without intubation were conducted. Airway examination revealed three subglottic cysts resulting in 90% obstruction (Figure 1, Figure 2). Endoscopic marsupialization with microscissors resulted in improvement in airway diameter (Figure 3, Figure 4). Postoperatively, the patient was observed in the Intensive Care Unit and was then discharged home after 24 hours. One year later, she remains free of respiratory symptoms.


Subglottic cysts are a rare complication of endotracheal intubation, and symptoms may not present for months following extubation, likely due to continued cyst growth [1,2]. Clinical presentation can be nonspecific, including generalized respiratory symptoms and failure to thrive 2. Surgical evaluation is diagnostic and allows for therapeutic intervention, with cyst marsupialization being the standard of care [2]. Prompt diagnosis and treatment can be lifesaving.

Acknowledgments

Author Contributions: Katelyn Scharf and Stephanie L Kahntroff: Involved in patient care, data and information collection, manuscript preparation, and manuscript review. 

Stephanie E Jones: Involved in data and information collection, manuscript preparation, and manuscript review.

Funding Statement: Support was provided solely from institutional and/or department resources.

Ethical Approval: The authors of no ethical conflicts to disclose.

Consent: Written informed consent was obtained from patient’s parent according to institutional policy.

Prior Presentations: Virtual poster presentation at the Society for Pediatric Anesthesia Annual Meeting, February 2021.

Conflict of Interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Informed consent was obtained for this publication.

References

  1. Downing GJ, Hayen LK, Kilbride HW. Acquired subglottic cysts in the low-birth-weight infant. Characteristics, treatment, and outcome. Am J Dis Child. 1993;147(9):971–974.
  2. Soloperto D, Spinnato F, di Gioia S, Di Maro F, Pinter P, Bisceglia A, et al. Acquired subglottic cysts in children: A rare and challenging clinical entity. A systematic review. Int J Pediatr Otorhinolaryngol. 2021;140:110523.

Keywords

Subglottic cysts; Infant; Respiratory distress

Cite this article

Scharf K, Kahntroff SL, Jones SE. Subglottic cysts in a premature infant: a rare complication of prolonged intubation. Clin Case Rep J. 2022;3(3):1–2.

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