Thoracocervical cysts as a cause of stridor.

564-566. Thoracocervical cysts as a cause of stridor. In five patients with severe stridor four were shown to have as the cause a duplication of foregut and the fifth a cystic hygroma. All were managed surgically and are well. In one patient tracheal obstruction was so severe that asphyxia and an episode of cardiac arrest preceded surgical management. Foregut duplication, particularly in children, is an important and remediable cause of respiratory obstruction. In a seven-year period during which 82 patients with mediastinal cysts and tumours were managed surgically, five presented because of severe stridor. One patient experienced complete respiratory obstruction shortly after admission to hospital, followed by anoxic cardiac arrest. Resuscitation was successful after endotracheal intubation. In four patients the cause of tracheal obstruction was a duplication of foregut; in the fifth the lesion was a thoracocervical cystic hygroma. All were managed surgically and are well. CASE HISTORIES CASE 1 An African female of 20 months had experienced respiratory symptoms including wheeze for four months and had been urgently stridulous for a week before admission to hospital. Clinically a tense, cystic mass was palpable in the suprasternal notch. Radio-graphically the upper mediastinum was broad and the trachea slit-like and displaced to the right (Fig. 1). Through a transverse cervical incision a cyst was enucleated from the superior mediastinum. The histological features were those of foregut duplication. Stridor was relieved and convalescence uneventful. CASE 2 An African male child of 3 months was admitted with a story of ingravescent stridor over four weeks. Radiographically there was a well-defined opacity, convex laterally, flattened against the trachea and occupying most of the upper half of the right hemithorax. The trachea was displaced to the left and compressed. At right thoracotomy a tense cyst, the size of a tennis ball and shown to contain 100 ml of thick green mucus, was dissected off the trachea. The histological features were those of foregut duplication with a lining predominantly of ciliated columnar epithelium. CASE 3 An African child of 11 months had a history, radiological features, and surgical findings indistinguishable from those of case 2. CASE 4 An African man of 22 years was transferred from an outlying hospital with a history of increasing stridor. Accompanying radiographs (Fig. 2) showed the trachea to be displaced to the right and the upper mediastinum to be broad. Asphyxia and cardiac arrest shortly after admission were successfully managed. An …