Airway obstruction by laryngeal masses in sudden and homicidal deaths

Porzionato, Andrea; Macchi, Veronica; Rodriguez, Daniele; De, Raffaele

doi:10.1016/j.forsciint.2007.05.003

Cited by 12 publications

(13 citation statements)

References 29 publications

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“…Although no previous history was available, it appears likely that this large tumor mass moved with respiration or during coughing and caused a “ball valve” type of occlusion of the laryngeal entrance resulting in asphyxiation. A case of homicide has been reported where acute upper airway obstruction was initiated by manual strangulation which damaged the vasculature of a cavernous laryngeal hemangioma and caused death due to extensive interstitial hemorrhage compressing the airway . There was, however, no evidence of neck trauma/bruising or interstitial soft tissue bleeding in the reported case.…”

Section: Discussionmentioning

confidence: 82%

Acute Fatal Upper Airway Obstruction from an Occult Cavernous Hemangioma of the Larynx

Kiho

Byard

2014

Journal of Forensic Sciences

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A 42-year-old previously well man collapsed while holding his throat. Resuscitation was unsuccessful, and at autopsy, the most significant findings were limited to the larynx, pharynx, and anterior mediastinum where there were multinodular dark blue tumors. Within the larynx, the lower border of the tumor was well demarcated, not extending beyond the vocal cords. A separate large polypoidal tumor mass was attached to the right aryepiglottic fold by a thin fibrous stalk. Histologic examination revealed numerous large, thin-walled cavernous-type vascular spaces typical of a multifocal cavernous hemangioma. Death was due to asphyxiation from obstruction of the upper airways by a cavernous hemangioma of the larynx. Adult laryngeal hemangiomas are rare and are usually supraglottic. This case demonstrates that pedunculated laryngeal cavernous hemangiomas may remain occult until the initiation of an obstructive episode with sudden collapse and death. In such instances, the diagnosis must rely upon an autopsy examination.

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Section: Discussionmentioning

confidence: 82%

Acute Fatal Upper Airway Obstruction from an Occult Cavernous Hemangioma of the Larynx

Kiho

Byard

2014

Journal of Forensic Sciences

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“…Unfortunately, we have not a fiberoptic bronchoscopy or a video laryngoscope device. In some cases, mask ventilation is achieved with great difficulty, direct laryngoscopic oral intubation might not be achieved and urgent tracheostomy might be required [5,8]. In the cases in which laryngeal view is blocked by the cyst, glottis might be visualized with the aspiration of the cyst content and tracheal intubation might be achieved.…”

Section: Discussionmentioning

confidence: 99%

“…These cysts might be asymptomatic or might be associated with airway obstruction, feeding difficulties and failure to thrive during infancy, and even with death due to severe laryngeal obstruction [3][4][5]. In cases with laryngeal inlet obstruction due to a vallecular cyst, the airway management sometimes might be a challenge [5][6][7]. In this case report, the airway management of an adult patient with difficult airway due to a large vallecular cyst completely obstructing the pharynx was presented.…”

Section: Introductionmentioning

confidence: 92%

“…They are rarely seen in adults and occur as a result of the tongue base mucus retention [1,2]. These cysts might be asymptomatic or might be associated with airway obstruction, feeding difficulties and failure to thrive during infancy, and even with death due to severe laryngeal obstruction [3][4][5]. In cases with laryngeal inlet obstruction due to a vallecular cyst, the airway management sometimes might be a challenge [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

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Airway Management in an Adult Patient With a Large Vallecular Cyst

Bestas

2014

J Med Cases

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Vallecular cysts are rarely seen in adults and occur as a result of the tongue base mucus retention. In cases with laryngeal inlet obstruction due to a vallecular cyst, the airway management sometimes might be a challenge. We presented the airway management of an adult patient with difficult airway due to a large vallecular cyst. A 28-year-old male patient with a large vallecular cyst was scheduled for surgical excision of the cyst under general anesthesia. Despite the use of different laryngoscopic blades, no laryngeal structure was seen due to the cystic formation. After aspiration of approximately 20 mL cyst content, the peripheral side of the epiglottis was seen on the left-upper side of the shrunken cyst. Therefore, laryngoscopy was performed by an insertion of the left side of the mouth, and tracheal intubation was achieved by endotracheal tube which was advanced blindly under the epiglottis. A week later, due to cyst reoccurrence, the patient was undergone surgery again. No problem arose during the course of anesthesia, surgical intervention and the postoperative period, and the patient was discharged on the fifth postoperative day. We concluded that the view of the glottis or other laryngeal structures can be obtained by shrinking the vallecular cyst size.

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“…This can happen both in the saccular [9,10] and ductal cysts [11][12][13]. Cases of sudden death are reported as anecdotal.…”

Section: Discussionmentioning

confidence: 99%