Effectiveness of stenting with an intubation tube fora subglottic mass in an infant
Yuji Fujita,1 Hideki Hirabayashi,2 George Imataka,1 Shigemi Yoshihara1
1

Department of Pediatrics,
Dokkyo Medical University,Shimotsuga, Tochigi, Japan2
Department ofOtorhinolaryngology—Headand Neck Surgery, Dokkyo
Medical University, Shimotsuga,
Tochigi, Japan
Correspondence toDr Yuji Fujita;​fujitay@​dokkyomed.​ac.​jp
Accepted 12 June 2020

DESCRIPTION

A 1-­month-­old girl was referred to the emergency
department owing to stridor and severe respiratory distress. We suspected pertussis owing to awhooping-­like cough and stridor. However, 5 daysof azithromycin administration was not effective inameliorating her stridor. Moreover, loop-­mediatedisothermal amplification for pertussis was negative.
Therefore, we performed bronchofiberscopy, andbulging in the subglottic tracheal membrane wasobserved (figure 1). The surface of the bulging area
comprised the tracheal mucosa. Since her respiratory distress intensified, the girl was intubated.
Intubation was performed smoothly, without resistance. After tracheal intubation, her stridor disappeared quickly and her respiratory status improved
immediately.
Neck MRI showed a compressed mass, with ahigh T2 signal; thus, haemangioma and lymphangioma were suspected (figure 2). The mass
may have been soft, based on its compression by
the intubation tube. The patient’s parents did notprovide consent for tracheostomy. Therefore, she
was observed under tracheal intubation, and thestenting effect of the intubation tube was closelymonitored. Neck MRI at 13 days after intubation
showed no mass. We performed extubation andprepared for an emergency tracheostomy 20 days
after intubation. After extubation, she did notpresent with respiratory distress and was discharged
1 month later. She has remained free of recurrenceat the age of 6 months.
Laryngomalacia is known to be a common causeof stridor during the neonatal period or infancy.
However, subglottic diseases such as tracheomalacia
and subglottic haemangioma should also be considered carefully when performing bronchofiberscopy.1

Figure 2arrow).

Neck MRI showing a compressed mass (whiteThe possibility of vascular compression of thetrachea should be considered because the surfaceof the bulging area comprises the tracheal mucosa.2However, in our case, cardiac ultrasonography
and MRI revealed no abnormality of vessels. MRIfindings suggested that the mass content might
have been liquid, which indicated the possibilityof haemangioma and lymphangioma. There aresome case reports indicating that these diseases
in the subglottic region can cause life-­threatening
upper airway obstruction.3 4 This case could not bediagnosed by MRI and endoscopic findings, anda tracheotomy was required for biopsy. However,even if a biopsy had been performed after tracheostomy, we may not have been able to diagnose
the type of mass because the content of this mass
may have been liquid. Therefore, stenting with

Patient’s perspective
We were worried about the tracheostomy. As aresult, we were glad that a tracheostomy had notbeen performed.

Learning points© BMJ Publishing Group
Limited 2020. No commercial
re-­use. See rights andpermissions. Published by BMJ.
To cite: Fujita Y,
Hirabayashi H, Imataka G,
et al. BMJ Case Rep
2020;13:e235904.
doi:10.1136/bcr-2020235904►► Paediatricians should consider a possibility for

Figure 1 Bulging of the subglottic tracheal membrane(white arrow) is observed on bronchofiberscopy.

a subglottic mass in a patient with stridor andrespiratory distress.
►► Paediatricians should consider carefully whether
to perform biopsy in subglottic lesions.
►► Stenting with an intubation tube for a subglottic
mass may be expected before tracheostomy.

Fujita Y, et al. BMJ Case Rep 2020;13:e235904. doi:10.1136/bcr-2020-235904

1BMJ Case Rep: first published as 10.1136/bcr-2020-235904 on 30 June 2020. Downloaded from http://casereports.bmj.com/ on June 30, 2020 at Dokkyo Medical University. Protected bycopyright.

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long-­term tracheal intubation may be a worthwhile treatment
option for a subglottic mass before tracheostomy.
Contributors YF: drafted and revised the initial manuscript. HH, GI and SY:
critically revised the manuscript for important intellectual content. All authors readand approved the final manuscript.
Funding The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-­for-­profit sectors.
Competing interests None declared.
Patient consent for publication Parental/guardian consent obtained.

Provenance and peer review Not commissioned; externally peer reviewed.

REFERENCES

1 Pfleger A, Eber E. Assessment and causes of stridor. Paediatr Respir Rev
2016;18:64–72.
2 Ida JB, Thompson DM, stridor P. Pediatric stridor.. Otolaryngol Clin North Am
2014;47:795–819.
3 Ajmi H, Mama N, Hassayoun S, et al. Life-­Threatening subglottic hemangioma in an
infant successfully treated with propranolol. Arch Pediatr 2018.
4 Kenton A, Duncan N, Bhakta K, et al. Laryngeal lymphatic malformation in a newborn. JPerinatol 2003;23:567–71.

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2Fujita Y, et al. BMJ Case Rep 2020;13:e235904. doi:10.1136/bcr-2020-235904

BMJ Case Rep: first published as 10.1136/bcr-2020-235904 on 30 June 2020. Downloaded from http://casereports.bmj.com/ on June 30, 2020 at Dokkyo Medical University. Protected bycopyright.

Images in…