The Different Clinical Aspects of Pediatric Primary Airway Tumors in the Larynx, Trachea, and Bronchi

Airway Obstruction from a Tracheal Mass in a 5-Year-Old: A Case Report

ABSTRACT

Stridor is a common presenting symptom for children in emergency departments (EDs) and usually represents an infectious process, such as croup, or aspiration of a foreign body. We present the case of an otherwise healthy 5-year-old girl with episodic increased work of breathing for several months that was initially diagnosed as asthma by her primary care physician. She subsequently presented to the ED with acutely worsening noisy breathing and dyspnea. Patient and parent denied any recent foreign body ingestions or choking episodes. We gave multiple doses of racemic epinephrine in the ED without symptom improvement. A lateral neck x-ray showed an occlusive subglottic airway mass. Otolaryngology (ENT) evaluation demonstrated an 85% airway occlusion. The mass was partially resected, resolving all of her respiratory symptoms. Although primary airway tumors in children are rare, they must be considered on the differential diagnosis of new noisy breathing or respiratory distress. Failure to diagnose these tumors in a timely manner can be life-threatening.

A solitary supraglottic neurofibroma presenting with obstructive sleep apnea in an adolescent

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Obstructive sleep apnea (OSA) is commonly encountered in the pediatric population and has a large differential diagnosis. As clinicians, we must determine who needs to undergo flexible laryngoscopy to rule out potential obstructing lesions causing OSA. This report presents a 16-year-old female who presented with snoring, "asthma," dysphagia, and OSA. Flexible laryngoscopy and computed tomography revealed a neurofibroma of the aryepiglottic fold without associated neurofibromatosis type 1. The patient underwent microlaryngoscopy and the lesion was excised using cold steel and a carbon dioxide laser. At 6 months' follow-up, the patient was breathing without difficulty and had no evidence of recurrence. Solitary laryngeal neurofibromas are extremely rare, and this is the first case of an adolescent with OSA caused by a solitary supraglottic neurofibroma. A supraglottic mass needs to be considered in the differential diagnosis of patients with OSA who fail conservative treatment, even a diagnosis as rare as a solitary laryngeal neurofibroma.

Clinical significance of interventional therapeutic bronchoscopy combined with bronchial arterial embolization in the treatment of hypervascular primary airway tumors in children

IMPORTANCE

Pediatric hypervascular primary airway tumors are progressive, fatal lesions with a low incidence, and the disease is often more serious than that in adults.

OBJECTIVE

To evaluate the clinical efficacy and safety of interventional therapeutic bronchoscopy combined with conservative treatment and bronchial arterial embolization in children with primary airway tumors.

METHODS

We retrospectively analyzed the clinical data of four pediatric patients with hypervascular primary airway tumor between 2017 and 2019 at Beijing Children's Hospital.

RESULTS

Two patients were low-grade bronchial mucoepidermoid carcinoma, one patient was pleomorphic adenoma, and one was bronchial leiomyoma. Interventional therapeutic bronchoscopy combined with bronchial arterial embolization was used for treatment (all four patients received general anesthesia). The tumors were safely resected in all patients via interventional bronchoscopy. There were no severe complications related to the procedures. All patients were followed up for 5-12 months, and one low-grade bronchial mucoepidermoid carcinoma recurred.

INTERPRETATION

Interventional therapeutic bronchoscopy combined with bronchial arterial embolization appears to be a safe and efficient therapeutic method associated with less trauma and fewer complications, including no serious adverse events, in children with hypervascular primary airway tumors without bronchus wall infiltration.