Chronic congestion with oral feeds in the presence of subglottic stenosis: a case report

Abstract

Abstract Background Subglottic stenosis is the narrowing of the airway below the vocal folds. It can present as a congenital or acquired condition. The primary clinical presentation is often noted as noisy breathing, also known as stridor. Diagnosis in the infant pediatric population poses challenges due to age-related factors and symptom variability. This case report highlights a pediatric patient whose predominant symptom was congestion during oral feeds. Case presentation A 3-month-old pre-term male, intubated following an episode of ventricular fibrillation with underlying viral infection, presented with prolonged, persistent congestion with oral feeds. Given persistent congestion, the differential diagnosis included aspiration, recovery from a viral illness, reflux, and an anatomical stricture. A videofluoroscopic swallow study was completed and ruled out oropharyngeal dysphagia from the differential. Despite this exclusion and the patient’s eventual recovery from his viral illness, congestion with oral feeds continued to worsen. A fiberoptic endoscopic evaluation was completed and revealed Grade 2 subglottic stenosis. The patient required immediate intervention via balloon dilation in the operating room. Conclusions Acquired subglottic stenosis is often a consequence of intubation. Symptoms are variable and can be difficult to diagnose in pediatric patients. Timely intervention is essential to prevent life-threatening conditions.