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A child with severe stridor
  1. Tai-Heng Chen1,2,
  2. Yung-Hao Tseng1,
  3. San-Nan Yang2
  1. 1 Division of Pediatric Emergency, Department of Emergency, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  2. 2 Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  1. Correspondence to Dr Tai-Heng Chen, Department of Pediatrics, Kaohsiung Medical University Hospital, No. 100, Tzyou 1st Road, Kaohsiung 807, Taiwan; taihen{at}kmu.edu.tw

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A 4-year-old boy presented to the emergency department with 1 week's fever and sore throat, associated with progression of respiratory distress since 3 days. He had significant stridor, nasal flaring and marked suprasternal recessions. Parents denied history of foreign body ingestion. Dyspnoea and stridor exacerbated on lying supine and was partially relieved by sit-up position. Physical examination revealed enlarged and exudative tonsils and bilateral cervical lymphadenopathy with tenderness. Neck x-ray, followed by CT, were performed (figures 1 and 2). Subsequent laboratory exams revealed positive heterophile antibodies (Monospot test) and EBV serology.

Figure 1

Lateral neck x-ray showing a huge oropharyngeal mass (arrow) resulting in nearly complete obstruction of the upper airway.

Figure 2

Postcontrast neck CT showing narrowed airway and diffusely enlarged adenoid, Waldeyer's ring, and the bilateral palatine tonsils.

Infectious mononucleosis (IM), mainly resulting from Epstein-Barr virus infection, usually has a benign, self-limited course. The overall incidence of upper airway obstruction complicating acute IM is less than 5%, but it may present as a potentially life-threatening situation demanding emergency intervention.1 However, airway compromise, though a well documented acute complication of IM, is often overlooked in differential diagnosis of severe stridor in children. Obstructive symptoms often resolve with head-of-bed elevation, intravenous hydration, humidification and systemic corticosteroids. In rare instances, severe panpharyngeal and transglottic oedema may necessitate endotracheal intubation, or even emergent tracheostomy. Furthermore, acute tonsillectomy has emerged as the preferred surgical intervention.1

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Footnotes

  • Contributors THC contributed to acquisition of data, revising the manuscript critically for important intellectual content, and final approval of the version to be published. YHT contributed to acquisition of data, or analysis and interpretation of data. SNY contributed to acquisition of data, analysis and interpretation of data, and drafting the manuscript for intellectual content.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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