Radiological Case of the Month FREE

A 20-MONTH-OLD infant had a 4-week history of bilaterally bulging neck masses that were apparent while crying. The masses were initially noted after an upper respiratory infection, and they became progressively more prominent. The infant had several episodes of difficulty swallowing, mild hoarseness, and occasional perioral cyanosis during a 5-day hospitalization to evaluate the neck masses. The infant's medical history was notable for respiratory syncytial virus bronchiolitis at age 6 months and several episodes of otitis media. There was no history of trauma or surgery.

Physical examination showed a playful child in no respiratory distress but with prominent bulging of the supraclavicular fossae bilaterally (Figure 1) on crying. The swelling disappeared when the infant was consoled (Figure 2), and the remainder of the physical examination was normal.

A flexible fiberoptic bronchoscopy showed no laryngeal or tracheal abnormality during quiet breathing, crying, or coughing. A barium esophagogram and chest computed tomography scan were normal. Chest and neck radiographs were obtained under fluoroscopy while the child was crying (Figure 3) and quiet (Figure 4).

Accepted for publication July 12, 2000.

Reprints: Nighat F. Mehdi, MD, Pediatric Allergy and Pulmonary Division, University of Iowa College of Medicine, 200 Hawkins Dr, Iowa City, IA 52242-1083 (e-mail: MehdiN@mail.medicine.uiowa.edu).