Vallecular cyst, a Forgotten Differential Diagnosis for Stridor and Failure to Thrive

Introduction: Vallecular cyst is a rare uni-locular laryngeal cyst that can cause upper airway obstruction.We report an infant with stridor and failure to thrive caused by vallecular cyst.

Case: A 3 month old full term male presented to our Neurology outpatient clinic for assessment of hypotonia, in the clinic patient was found to have failure to thrive, history of repeated chocking with feeds and inspiratory stridor which is associated with cyanosis, patient Immediately was admitted to Pediatric ward for further workup and evaluation. A multidisciplinary team including general pediatrics, neurology, pulmonology, Otolaryngology ENT, dietician and speech therapy evaluated the patient and the plan was to proceed with Brain MRI, bronchoscopy to evaluate upper airway and swallowing assessment, flexible bronchoscopy was done and showed vallecular cyst (figure-1) with normal larynx & Trachea ,which was removed immediately by (ENT) , histopathology assessment of the cyst showed connective tissue covered by non-keratinizing squamous epithelium with vascular congestion and chronic inflammation, which is compatible with vallecular cyst diagnosis. Patient was discharged in a good general condition with regular follow up in the clinic, upon visit to the clinic patient was growing well (figure 2) with no residual stridor, swallowing defect or hypotonia.

Discussion: Vallecular cyst is a rare congenital unilocular laryngeal cyst arising from beneath the mucosa of the vallecula. It contain clear fluid and consist of respiratory epithelium.

Majority of reported cases were full term infants who presented during the first few weeks of life with stridor, respiratory distress, feeding problems and failure to thrive.

It is by direct laryngo-bronchoscopy with immediate surgical removal as final treatment.

The late diagnosis of our case was due to low suspicion index of clinicians, infants presenting with stridor since birth need prompt review in a specialized pediatric center for possible direct airway assessment.