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Clinical Problem Solving
September 2013

Apneic Episodes and Sternal Retractions in an Infant

Author Affiliations
  • 1Georgia Health Sciences University, Augusta
  • 2Tawam Hospital, Johns Hopkins Medicine, Al Ain, United Arab Emirates
JAMA Otolaryngol Head Neck Surg. 2013;139(9):957-958. doi:10.1001/jamaoto.2013.4092

An infant boy known to have a secondary cleft palate presented with apneic episodes and sternal retractions. He had been delivered vaginally at term, with the pregnancy complicated by preeclampsia and oligohydraminos.

On examination there was a 3-cm, smooth, whitish tan mass emanating from the right lateral pharyngeal wall (Figure, A) and protruding down through the secondary cleft palate. A contrast-enhanced maxillofacial computed tomographic (CT) scan was obtained. This revealed a well-defined, round heterogeneous, midline mass obstructing the oropharynx and posterior nasopharynx (Figure, B-D). The mass had a mildly enhancing thick wall with a central focus of decreased enhancement, with attenuation similar to fluid. No discrete foci of calcification or fat were identified.

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