Subglottic cysts and asymmetrical subglottic narrowing on neck radiograph

Abstract

The congenital subglottic hemangioma typically appears as an asymmetric subglottic narrowing or mass on frontal neck radiographs. Therefore, soft tissue neck radiography has been advocated as a definitive non-operative approach for diagnosing these lesions. However, we have noted similar asymmetric subglottic narrowing in patients with acquired subglottic cysts. These retention cysts occur following long-term intubation in the neonate. The mechanism probably involves subglottic fibrosis which obstructs glands with subsequent cyst formation. Acquired subglottic cysts typically appear as an asymmetric narrowing on frontal or lateral soft tissue neck radiographs. These lesions may produce airway compromise but are effectively treated by forceps or laser removal. Acquired subglottic cysts must be included in the differential diagnosis of asymmetric subglottic narrowing. The definitive diagnosis is made by direct laryngoscopy, not soft tissue neck radiograph.

Evaluation of pediatric subglottic cysts

“…There are imaging studies in the work-up of SGC, but they are not diagnostic. Frontal and lateral neck radiographs may show asymmetric subglottic narrowing [2,8,[13][14][15]]. An article regarding MRI's use in subglottic cysts advocates that better preoperative counseling and enhanced ability to choose the proper surgical procedure may be attained with MRI [16].…”

“…These cysts were found to have spontaneously resolved or decreased in size with time [17,18]. Bronchoscopic rupture and decompression, endoscopic marsupialization either with laser (carbon dioxide or contact diode) or with cup forceps and microlaryngeal scissors should be the primary method of treatment [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. All of our patients' underwent endoscopic marsupialization with cold steel instruments or CO 2 laser and mechanical decompression with balloon dilatation.…”

“…The first case of SGC was published in 1968 by Wigger and Tang [5]. In the previous years there are 15 articles presenting approximately 130 cases of SGC (117 of which were reported from 1990 to 2007) [2,[6][7][8]1,[9][10][11][12][13][14][15][16][17][18][19][20][21]. SGCs have been subdivided into congenital or acquired types.…”

Management of subglottic cysts with Mitomycin-C—A case series and literature review

“…Frontal and lateral neck radiographs may show asymmetric subglottic narrowing [5,[11][12][13]. A published article regarding MRI's use in subglottic cysts advocates that better preoperative counseling and enhanced ability to choose the proper surgical procedure may be attained with MRI [14].…”

“…Marsupialization of the cysts is considered to be the most effective method of treating subglottic cysts: both from a risk and recurrence perspective [2][3][4][5][6][12][13][14][15][16]18]. Marsupialization is typically accomplished with a CO 2 laser or cold steel forceps.…”