Monday, August 27, 2012


A newborn girl presents in the first few days of life with upper airway obstruction and noisy breathing. On feeding, she becomes cyanotic, which resolves when she cries. To help, you try to place a nasal trumpet to relieve obstruction but cannot advance the 6 French catheter. An oral airway helps the obstruction until definitive surgery can occur. CT is shown below.

Challenge: What's the diagnosis?

Image shown under Fair Use.


Anonymous said...

choanal atresia

elnaz boki said...

Choanal atresia.The cause of choanal atresia is unknown. It is thought to occur when the thin tissue separating the nose and mouth area during fetal development remains after birtSymptoms

Newborns generally prefer to breathe through their nose. Typically, infants only mouth breathe when they cry. Babies with choanal atresia have difficulty breathing unless they are crying.

Choanal atresia may affect one or both sides of the nasal airway. Choanal atresia blocking both sides (bilateral) of the nose causes acute breathing problems with cyanosis and breathing failure. Infants with bilateral choanal atresia may need resuscitation at delivery. More than half of infants have a blockage on only one side, which causes less severe problems.

Symptoms include:

Chest retracts unless the child is breathing through mouth or crying

Difficulty breathing following birth, which may result in cyanosis (bluish discoloration), unless infant is crying

Inability to nurse and breathe at same time

Inability to pass a catheter through each side of the nose into the throat

Persistent one-sided nasal blocka

Jax said...

Choanal atresia!

Anonymous said...

Choanal atresia?

Craig Chen said...

yes...nice answers..thanks for the detail elnaz boki.

This is choanal atresia, the obliteration or blockage of the posterior nasal aperture. It is often associated with bony abnormalities of the pterygoid plates and midfacial growth anormalities. CT shows narrowing of the posterior nasal cavity at the level of pterygoid plate.

Source: UpToDate.