A 6.3-kg (13.9-lb) 4-hour-old female Huacaya alpaca cria, accompanied by its dam, was admitted to a veterinary medical teaching hospital because of respiratory distress and difficulty nursing since birth (day 0). On admission, the cria was bright, alert, and responsive; it was able to stand on its own, and had a suckle reflex. The cria was tachycardic (heart rate, 160 beats/min) and had open-mouth breathing (80 breaths/min); its rectal temperature was within the reference range at 37.5°C (99.5°F). The oral mucous membranes were cyanotic, and no airflow could be detected from either nostril during expiration. Introduction of a 5F flexible red rubber tube into the ventral meatus of each nostril revealed the lack of patency of either of the choanae. On the basis of these findings, a presumptive diagnosis of congenital complete bilateral choanal atresia was made. Evaluation of the head by CT was recommended to confirm the diagnosis and determine the type of choanal obstruction.Supplemental oxygen delivery was initiated via face mask at a rate of 5 L/min. The patient was anesthetized and intubated orotracheally, and CT images