Ginty Olivia, Pundaky Gabrielle, Lam Jennifer, Qiabi Mehdi, Mullowney Tara, McKillop Scott, Ross Ian, Strychowsky Julie
Department of Otolaryngology-Head & Neck Surgery, Schulich School of Medicine & Dentistry, London, Ontario, Canada.
Schulich School of Medicine & Dentistry, London, Ontario, Canada.
Breastfeed Med. 2025 Aug;20(8):593-597. doi: 10.1089/bfm.2025.0083. Epub 2025 May 26.
Due to their nonspecific symptoms, foreign bodies in the aerodigestive tract (FBA) are often misdiagnosed as respiratory conditions, especially when unwitnessed, posing significant risks for morbidity and mortality in the pediatric population. We report a case of an otherwise healthy 4-month-old, predominantly breastfed infant with episodic "honking" breathing, choking with feeds, and a 2-month history of recurrent croup episodes requiring emergency services and an hospital admission. After referral to pediatric otolaryngology/respirology, a flexible laryngoscopy revealed a diagnosis of mild laryngomalacia, inconsistent with the severity of symptoms. A formal airway evaluation was performed, including supraglottoplasty. Unexpectedly, extraluminal pulsatile tracheal compression was found, with correlating computed tomography findings of an innominate artery variation and a paraesophageal abnormality. This abnormality appeared as a fluid-filled density between the esophagus and trachea on magnetic resonance imaging, without patency to the esophagus on Upper GI series. Differential diagnoses included vascular malformation, esophageal diverticulum, and bronchogenic/foregut duplication cyst. Although evaluation with echoendoscopy was considered, collaboration with general/thoracic surgery for a flexible esophagoscopy revealed a 2-cm breast pump membrane embedded in a pseudo-diverticulum with a sealed esophageal perforation, which concluded with successful object removal via forceps. The patient's respiratory symptoms have resolved; however, persistence of the pseudo-diverticulum on follow-up imaging and endoscopy warrants ongoing surveillance. This case demonstrates the challenging diagnosis of a breast pump membrane as an unexpected esophageal FBA, compounded by nonspecific respiratory symptoms and the membrane's near-radiolucency on standard imaging. The exhibited multidisciplinary, collaborative approach was fundamental for the complication-free removal of the membrane.
由于其非特异性症状，气道消化道异物（FBA）常被误诊为呼吸道疾病，尤其是在无目击情况下，这对儿童群体的发病率和死亡率构成重大风险。我们报告一例病例，一名4个月大、主要母乳喂养的健康婴儿，有发作性“呼噜”呼吸、喂奶时呛噎症状，并有2个月反复喉炎发作史，需紧急医疗服务并住院治疗。转诊至儿科耳鼻喉科/呼吸科后，柔性喉镜检查诊断为轻度喉软化症，与症状严重程度不符。进行了正式的气道评估，包括声门上成形术。出乎意料的是，发现了管腔外搏动性气管压迫，计算机断层扫描结果显示无名动脉变异和食管旁异常。磁共振成像显示该异常表现为食管与气管之间充满液体的密度影，上消化道造影显示食管未通畅。鉴别诊断包括血管畸形、食管憩室和支气管源性/前肠重复囊肿。尽管考虑了超声内镜评估，但与普通外科/胸外科合作进行柔性食管镜检查时，发现一个2厘米的吸奶器膜嵌入假性憩室，伴有密封的食管穿孔，最终通过镊子成功取出异物。患者的呼吸道症状已缓解；然而，随访成像和内镜检查中假性憩室持续存在，需要持续监测。该病例表明，吸奶器膜作为意外的食管FBA诊断具有挑战性，非特异性呼吸道症状以及该膜在标准成像上几乎不透射线使情况更加复杂。所展示的多学科协作方法对于无并发症地取出该膜至关重要。
