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Otolaryngology

A Nearly Obstructive Intratracheal Mass in a Pediatric Patient

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.

1 Credit CME

JAMA Otolaryngology–Head & Neck Surgery

Published Online: February 2, 2023

Clinical Challenge

Article Information and Disclosures

Amir A. Hakimi, MD¹;

Nicklas C. Orobello, MD²;

Pamela A. Mudd, MD, MBA²

Author Affiliations

¹Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, Washington, DC
²Department of Otolaryngology, Children’s National Medical Center, Washington, DC

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A 12-year-old girl presented to the clinic with a 3-month history of intermittent stridor. Her symptoms were initially most prominent while playing sports and were suspected to be due to asthma or seasonal allergies. However, medical management with albuterol, intranasal fluticasone, and cetirizine failed to provide relief. More recently, the patient’s parents noted that she developed stridor while sleeping and while at rest, prompting the family to present for medical attention.

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A 12-year-old girl presented to the clinic with a 3-month history of intermittent stridor. Her symptoms were initially most prominent while playing sports and were suspected to be due to asthma or seasonal allergies. However, medical management with albuterol, intranasal fluticasone, and cetirizine failed to provide relief. More recently, the patient’s parents noted that she developed stridor while sleeping and while at rest, prompting the family to present for medical attention.

Previous workup, including pulmonary function testing, was concerning for an upper airway obstructive process, for which she was referred to otolaryngology. In-office flexible videostroboscopy revealed a mass in the distal cervical trachea that appeared nearly obstructive. Chest radiography confirmed the presence of an approximately 1.5-cm, well-circumscribed soft tissue mass within the cervical trachea.

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Article Information

Corresponding Author: Amir A. Hakimi, MD, Department of Otolaryngology–Head and Neck Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (amir.a.hakimi@medstar.net).

Published Online: February 2, 2023. doi:10.1001/jamaoto.2022.4908

Conflict of Interest Disclosures: Dr Mudd reported personal fees from Innomed outside the submitted work. No other disclosures were reported.

Additional Contributions: We thank the patient’s mother for granting permission to publish this information. We also thank Justin Kurtz, MD, and Christopher Rossi, MD, from the Department of Pathology, Children’s National Medical Center, for their assistance in histopathologic analysis. They were not compensated for their contributions.

References

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Ally M , Kinshuck AJ , Rouhani M , Sandison A , Sandhu GS . The surgical management of recurrent tracheal schwannoma. AME Case Rep. 2018;2:16.PubMed Google Scholar Crossref

Huang HR , Li PQ , Wan YX . Primary intratracheal schwannoma misdiagnosed as severe asthma in an adolescent. World J Clin Cases. 2021;9(17):4388-4394.PubMed Google Scholar Crossref

Wu L , Sha MC , Wu XL , Bi J , Chen ZM , Wang YS . Primary intratracheal neurilemmoma in a 10-year-old girl. World J Clin Cases. 2021;9(29):8888-8893.PubMed Google Scholar Crossref

Afsin E , Yaksi O , Önal A , Bacaksiz E . Tracheal schwannoma mimicking asthma. Int J Neurosci. 2022;1-5. Published online August 9, 2022.PubMed Google Scholar

Dorfman J , Jamison BM , Morin JE . Primary tracheal schwannoma. Ann Thorac Surg. 2000;69(1):280-281.PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.