背景:变应性鼻炎是初级护理环境中最常见的变应性疾病。临床诊断通常基于对经验性治疗的反应。然而,长期治疗失败和/或不典型疾病表现,应考虑鉴别诊断。以下是青少年中不寻常和罕见的声门下气管血管平滑肌瘤错构瘤的报告,治疗多年的过敏性鼻结膜炎和哮喘。
方法:一名12岁的白种人被转诊到过敏诊所,有支气管痉挛和鼻结膜炎症状的终生史,治疗多年的哮喘和环境过敏。咳嗽,后鼻引流,自我描述为“痰中窒息,喉咙里有一种拍打的感觉,\",在初步评估前5个月恶化。常见环境过敏原的穿刺皮肤试验为阴性。肺活量测定,因慢性咳嗽病史而进行,显示用力呼气相钝化。胸部X光片,立即下令排除可能的肺外梗阻,显示双侧基底浸润。胸部的非对比计算机断层扫描,下令进一步阐明X射线的发现,显示声门下气管肿块.在随后的转移和入住三级医院中心后,显微喉镜,支气管镜检查,进行微悬浮喉镜检查以去除气管肿块。病理证实鳞状粘膜伴息肉样血管平滑肌瘤改变,慢性炎症特征符合血管平滑肌瘤错构瘤。手术干预是成功的,术后1年随访显示,无症状的青少年儿童,肺功能正常。
结论:尽管鼻后引流和咳嗽是一般患者人群的典型表现症状,它们可能具有临床影响力,因为它们可以掩盖更严重的医疗状况。详细的病史和仔细的体格检查可能会提供高度怀疑疾病的指标,并且可以帮助鉴别诊断。该病例报告是儿科文献中首次报道的声门下错构瘤,临床表现为环境过敏和哮喘症状。
BACKGROUND: Allergic rhinitis is the most common allergic disease encountered in a primary care setting. Diagnosis is often made clinically based on response to empiric therapy. However, with long-term treatment failure and/or atypical disease presentation, a differential diagnosis should be considered. The following is a report of an unusual and rare presentation of a subglottic tracheal angiomyomatous hamartoma in an adolescent, treated for many years as allergic rhinoconjunctivitis and asthma.
METHODS: A 12-year-old Caucasian was referred to the allergy clinic with a lifetime history of bronchospasms and rhinoconjunctivitis symptoms, treated for many years for asthma and environmental allergies. Cough, posterior nasal drainage, self-described \"choking on phlegm,\" and a sensation of \"a flap in the throat,\", worsened 5 months prior to the initial evaluation. Puncture skin testing for common environmental allergens was negative. Spirometry, performed due to history of chronic cough, showed blunting of the forced expiratory phase. A chest X-ray, immediately ordered to rule out possible extrapulmonary obstruction, showed bilateral bibasilar infiltrates. A noncontrast computerized tomographic scan of the chest, ordered to further elucidate X-ray findings, revealed a subglottic tracheal mass. Following a subsequent transfer and admission to a tertiary hospital center, microlaryngoscopy, bronchoscopy, and microsuspension laryngoscopy were performed to remove the tracheal mass. Pathology confirmed squamous mucosa with polypoid angiomyomatous changes and chronic inflammatory features consistent with angiomyomatous hamartoma. Surgical intervention was successful, and follow-up 1 year postoperatively revealed a healthy, asymptomatic adolescent child with normal lung function.
CONCLUSIONS: Although posterior nasal drainage and cough are typical presenting symptoms in the general patient population, they may be clinically impactful as they could disguise more serious medical conditions. A detailed history and careful physical examination may provide a high index of suspicion of disease, and can help work the differential diagnosis. This case presentation is the first documentation of subglottic hamartoma reported in the pediatric literature with clinical manifestation of environmental allergy and asthma symptoms.