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This document presents a case study of a 2-year-old boy who presented with progressive respiratory distress over 1 month. Physical examination revealed biphasic stridor, supraclavicular retractions, and oxygen saturation of 94%. Flexible bronchoscopy showed large laryngeal papillomas causing near complete airway obstruction. Histopathology confirmed laryngeal papillomatosis. Any child with changing voice, stridor, or respiratory distress should undergo bronchoscopy to evaluate for laryngeal papillomatosis, which can cause progressive airway obstruction.

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Ahmad Ismatullah
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81 views

Poster

This document presents a case study of a 2-year-old boy who presented with progressive respiratory distress over 1 month. Physical examination revealed biphasic stridor, supraclavicular retractions, and oxygen saturation of 94%. Flexible bronchoscopy showed large laryngeal papillomas causing near complete airway obstruction. Histopathology confirmed laryngeal papillomatosis. Any child with changing voice, stridor, or respiratory distress should undergo bronchoscopy to evaluate for laryngeal papillomatosis, which can cause progressive airway obstruction.

Uploaded by

Ahmad Ismatullah
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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BIPHASIC STRIDOR AS A RESPIRATORY

SYMPTOM OF LARYNGEAL PAPILLOMATOSIS


Dimas Dwi Saputro, Rifan Fauzie, Retno Widyaningsih
Pediatric Respirology Division - Harapan Kita Women and Children

Background
Laryngeal papillomatosis has a hallmark of
Objective
progressive hoarseness, stridor, and respiratory
To present biphasic stridor with the possible
distress. Due to the fact that the most common
development of respiratory distress as a respiratory
symptoms are related to airway obstruction, many
symptom of laryngeal papillomatosis
children are misdiagnosed with croup, asthma, or
chronic bronchitis. The incidence of laryngeal
papilomatosis in children is 3.62 cases per 100.000.

Case
A two year-old boy came with a history of progressive
difficulty in the breathing since 1 month before admission.
He has evaluated in another hospital and refered to our
hospital where flexible bronchoscopy was performed due to
his respiratory distress
a b
Physical examinations revealed poorly nourished, anxious
child with grade III laryngeal obstruction (Freitag
classification). His respiratory rate was 40x/minutes. Severe
supra sternal retraction with biphasic stridor was noted. On
auscultation, bilateral air entry was reduced with his room air
saturation around 94%, his heart rate was 140/minutes.
No history of illness before

Flexible bronchoscopy examination revealed large polyp c d


arrising from glottis causing airway obstruction, and multiple
papilloma on both valve vocal cords. Histopathology
showed a paracheratotic squamous lesion with little
hyperplasia and polyploid form of the cell. Besides that, the
vessels were hyperemic in subepitelial space. This finding
consistent with laryngeal squamous papillomatosis

The lesions were removed by microlaryngeal excision in the


previous hospital. The boy was stable through out
procedures and was evaluated the reccurent of papilloma
e
monthly in outpatient clinic Figure 1. The flexible bronchoscopy
examination showed multiple laryngeal
papillomas and near complete obstruction
in supraglotic area (a,b,c,d)
Conclusion
Any child with voice changing, obstructive airway symptoms should get fiberoptic bronchoscopy to rule out
neoplasia with laryngeal papillomatosis being high on the differential. A careful history should be obtained in
persistent or progressive stridor and dysphonia with the possible development of respiratory distress

17th Indonesian Congress of Pediatrics (KONIKA XVII) Jogja, August 8-11, 2017

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