An Infected Third Branchial Pouch Cyst presenting with Acute Stridor in an Infant
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CLINICAL REPORT
An Infected Third Branchial Pouch Cyst presenting with Acute Stridor in an Infant Ramya Rathod1 • Sujoy Chatterji1 • Niveditha Damodharan1 • Sourabha K. Patro1
Received: 27 August 2020 / Accepted: 10 November 2020 Ó Association of Otolaryngologists of India 2020
Abstract Branchial pouch cysts clinically mimic deep neck space infection and misdiagnosis leads to surgical drainage which can complicate into a persistently draining sinus or fistula. We present a unique case of infected third branchial pouch cyst in an infant who presented with acute stridor and our experience in its management. Keywords Branchial pouch cyst Acute stridor Pediatric neck swelling Tracheostomy Difficult airway
Introduction A stridulous infant with an inflammed neck swelling raises suspicion of deep neck space infection or secondary infection in a pre-existing neck swelling. However, rare cases can safely be managed with high clinical suspicion as noted in our past experiences where a case of pseudo aneurysm presented mimicking an abscess [1]. Third and fourth branchial pouch anomalies are rare contributing to 1–2% of all branchial lesions and tend to present in early childhood [2]. Anomalies can be a sinus, a cyst or a fistula of which sinus is most common which has only one communication i.e., either with the skin or the pharynx. Cysts retain secretions and neither has an external nor an internal visceral opening whereas fistulae connect from the pharynx to the skin [3]. Third branchial pouch anomalies constitute 2–8% of all branchial anomalies. Fifty nine
& Sourabha K. Patro [email protected] 1
Department of Otolaryngology and Head and Neck Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
percent of cases are seen in 8 years and older children and upto 89% have left sided predominance. Most common presentation of third branchial anomalies is as a recurrent neck abscess. So far, no case of third branchial anomaly with acute stridor requiring immediate airway management have been reported in literature. However, cases of third branchial pouch anomalies with history of respiratory difficulty lasting for duration of weeks to months associated with thyroiditis or neck abscess or neck mass have been reported [4–6]. We report a case of a third branchial pouch cyst in an infant presenting with acute onset stridor which makes this situtation unique.
Case Report A 12 month old child presented to the pediatric emergency department with a 2 month history of gradually progressive left sided neck swelling associated with intermittent noisy breathing but with acute onset stridor since 2 h before presentation. There was no history of fever, upper respiratory tract infection, dysphagia or odynophagia, drooling, cyanotic spells or trauma. The child was delivered by Cesarean section at full term with no significant perinatal history with normal developmental history as per age. Clinical examination revealed absence of fever with intermittent tachypnoea with maximum recorded respiratory
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