title: Cervical lung herniation complicating a case of acute asphyxial asthma in a child.
abstract: The abrupt onset of respiratory failure secondary to asthma, known as acute asphyxial asthma (AAA) in adults, is uncommonly reported in children. Here, we report a case of a child with the acute onset of respiratory failure consistent with AAA complicated by the finding of a neck mass during resuscitation. This 11-year-old boy with a history of asthma initially presented in respiratory failure with altered mental status after the complaint of difficulty in breathing minutes before collapsing at home. Initially, his respiratory failure was thought to be secondary to status asthmaticus, and treatment was initiated accordingly. However, a neck mass noted during the resuscitation was cause for concern, and other etiologies for his respiratory failure were considered, including an airway obstructing neck mass. After pediatric surgery and anesthesia consultation for intubation and possible tracheostomy placement, general anesthesia was induced in the operating room with an inhaled anesthetic, with prompt resolution of the bronchspasm and decompression of the neck mass. Review of the imaging and clinical course ultimately yielded a diagnosis of cervical lung herniation as the etiology of his neck mass. We report this case of AAA and cervical lung herniation and a review of the literature of these 2 uncommon phenomena in children.
authors.affiliation: From the *Division of Emergency Medicine, The Children's Hospital of Philadelphia; †Department of Surgery, Division of Pediatric Surgery, University of California San Francisco, CA; and ‡Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Martchek
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Padilla
authors.forename: Mark R
authors.initials: MR
authors.lastname: Zonfrillo
authors.forename: Eron Y
authors.initials: EY
authors.lastname: Friedlaender
mesh_terms: D000208:Acute Disease; D001237:Asphyxia / Q000175:diagnosis / Q000209:etiology*; D001249:Asthma / Q000150:complications* / Q000175:diagnosis; D002648:Child; D006547:Hernia / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008168:Lung; D008297:Male; D009333:Neck; D013902:Radiography, Thoracic; D014057:Tomography, X-Ray Computed