Question
A newborn baby is not able to breathe after birth and presents with cyanosis on feeding.CT scan shows the following picture.What is the diagnosis?
A. Left Maxillary Sinusitis
B. Deviated Nasal Septum
C. Adenoid Hypertrophy
D. Bilateral Choanal Atresia
Show Answer
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Correct Answer ยป D Explanation |
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Ans:D. Bilateral Choanal Atresia.
Image shows:CT scan Axial view showing bilateral bony choanal Atresia.
CHOANAL ATRESIA
- Choanal atresia is a congenital disorder where the back of the nasal passage (choana) is blocked, usually by abnormal bony or soft tissue (membranous) due to failed recanalization of the nasal fossae during fetal development.
Presentation:
- It can be unilateral or bilateral.
- Sometimes, a unilateral choanal atresia is not detected until much later in life because the baby manages to get along with only one nostril available for breathing.
- Bilateral choanal atresia is a very serious life-threatening condition because the baby will then be unable to breathe directly after birth as babies are obligate nasal breathers (they mainly use their noses to breathe).
- In some cases, this may present as cyanosis while the baby is feeding, because the oral air passages are blocked by the tongue, further restricting the airway.
- The cyanosis may improve when the baby cries, as the oral airway is used at this time.
Diagnosis:
- Choanal atresia can be suspected if it is impossible to insert a nasal catheter.
- Also, if one notices a continuous stream of mucus draining from one or both nostrils, it could be a sign of an atresia.
- Another common sign is cyanosis in an infant while breast feeding, as breathing is dependent on nasal patency in this situation.
- Diagnosis is confirmed by radiological imaging, usually CT scan.
Treatment:
- Temporary alleviation can be achieved by inserting an oral airway into the mouth.
- However, the only definitive treatment is surgery to correct the defect by perforating the atresia to create a nasopharyngeal airway.
- A stent may be inserted to keep the newly formed airway patent or repeated dilatation may be performed
