Nordness M E, Zacharisen M C
Medical College of Wisconsin, Milwaukee, USA.
Ann Allergy Asthma Immunol. 1999 Dec;83(6 Pt 1):540-2. doi: 10.1016/S1081-1206(10)62866-9.
Functional causes of upper airway obstruction have focused primarily on psychogenic stridor associated with paradoxical vocal cord dysfunction. Angioedema can involve upper airway structures and be life-threatening.
We report a 12-year-old female with upper airway obstruction from posterior tongue swelling which was determined to be a conversion reaction.
METHODS & RESULTS: A lateral neck film revealed severe tongue swelling. Examination revealed a calm, cooperative patient in no distress but exhibiting inspiratory and expiratory stridor. A computed tomography scan revealed soft tissue fullness at the base of the tongue without associated lymphadenopathy. Laboratory evaluation was normal. With anesthetic induction in the operating room, there was complete relaxation of the upper airway with no evidence of tongue swelling, mass, or other abnormality. Following tongue biopsy, she had no reoccurrence of the tongue mass.
This case represents a childhood conversion reaction of functional airway obstruction where tongue manipulation simulated tongue swelling radiographically consistent with angioedema.
上气道梗阻的功能性病因主要集中在与矛盾性声带功能障碍相关的精神性喘鸣。血管性水肿可累及上气道结构并危及生命。
我们报告一名12岁女性，因后舌肿胀导致上气道梗阻，经诊断为转换反应。
颈部侧位片显示严重的舌肿胀。检查发现患者平静、配合，无痛苦，但有吸气和呼气性喘鸣。计算机断层扫描显示舌根部软组织饱满，无相关淋巴结肿大。实验室检查正常。在手术室进行麻醉诱导时，上气道完全松弛，没有舌肿胀、肿物或其他异常的迹象。舌活检后，她的舌肿物未再复发。
本病例代表了一例儿童功能性气道梗阻的转换反应，其中通过舌部操作模拟出与血管性水肿相符的舌肿胀。
