Presentation
Difficulty in breathing.
Patient Data
overdistension of the hypopharynx
cervical spine is straightened and leaning forward
enlarged palatine tonsils
enlarged pharyngeal tonsil (adenoid), with airway narrowing
epiglottis and aryepiglottic fold are normal
preserved vallecular air space
Case Discussion
Clinical examination revealed enlarged kissing palatine tonsils, post-nasal discharge and enlarged nasopharyngeal adenoids.
Lateral x-ray of the neck demonstrates distension of the hypopharynx, dilatation of the laryngeal ventricle and narrowing of the subglottic trachea suggestive of croup.
Distended hypopharynx occurs in multiple settings of upper airway obstruction such as croup, epiglottitis, subglottic stenosis, foreign body aspiration or ingestion and others.
Adenoid and palatine tonsils enlargement is common in children and is not a cause of enlarged hypopharynx and can be a double presentation in this case.
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