Presentation
Presented in respiratory distress with swelling of the neck.
Patient Data
On the neck projections, there is a soft tissue mass ventral to the larynx that is causing dorsal displacement of the ventral laryngeal wall. This in turn is causing marked narrowing of the laryngeal lumen.The oropharynx is widened indicating upper respiratory tract obstruction. In the thorax, the projections are moderately obliqued. However, the cardiopulmonary structures appear within normal limits.
Abscess of the larynx with airway obstruction. Differential diagnosis - neoplasia.
Case Discussion
An airway examination showed a severely swollen and discolored left arytenoid cartilage. A fine needle aspirate of the external mass contained degenerate neutrophils consistent with an abscess. Both arytenoids were in spasm with obstruction of air flow. Two foxtails were removed from the vaginal vault. The laryngeal abscess was presumed to be due to a migrating foreign body (grass awn).
The extraluminal location of this mass caused compression of the airway and an upper airway obstruction, and the inflammation contributed to laryngeal spasm. Airway obstructions can also be caused by intraluminal masses and foreign bodies.
Grass awns can enter orifices in multiple areas, in this case the oral cavity as well as the vaginal vault. There was no evidence of pulmonary involvement though this is a frequent occurence in grass awn disease.
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