Clinical Problem Solving: Pathology
March 2009

Pathology Quiz Case 1

Author Affiliations



Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Otolaryngol Head Neck Surg. 2009;135(3):320-324. doi:10.1001/archoto.2008.547-a

A 2-day-old boy presented at 12 hours of life with difficulty feeding and stridorous breathing. Despite intermittent respiratory distress in the neonatal intensive care unit, he did not require ventilatory support or become cyanotic. Physical examination revealed a neonate without craniofacial abnormality or syndromic stigmata. During exhalation, he demonstrated stertorous respirations, which were relieved by crying. Endoscopic examination revealed a polypoid soft-tissue mass based on a stalk at the posterior edge of the vomer. The mass occluded both posterior choanae with exhalation but was displaced posteriorly on inhalation, thus relieving the obstruction. The results of the rest of the head and neck examination were within normal limits. A computed tomographic scan of the patient's head demonstrated a soft-tissue density in the nasopharynx, more prominent on the left side, without complete obstruction (Figure 1).

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