Respiratory distress in a neonate: Inflation of a third branchial anomaly with positive airway pressure

Positive airway pressure from noninvasive ventilation is an essential tool for many pediatric patients with respiratory distress. We present a case of an unknown third branchial anomaly that was diagnosed following inflation with continuous positive airway pressure (CPAP), which exacerbated the infant's respiratory distress. In this paper, we report on a unique case of a neonate who develops respiratory distress from a third branchial cleft cyst that inflated upon initiation of CPAP. This patient ultimately failed conservative and medical management and required endoscopic cauterization of a piriform sinus tract. This case demonstrates the anatomy of these lesions in a unique way that explains the variability of their presentations.image