The thyroglossal duct cyst and respiratory failure in neonates: Case report and review of an unusual entity

Thyroglossal duct cysts are unusual neck lesions in neonates. Most cysts are first noticed in preschool-aged children as a small midline neck swelling, and can become infected causing inflammation, erythema, and external drainage. In this patient population respiratory symptoms are frequently part of the initial presentation, and respiratory failure due to cyst mass effect is often fatal in newborns. The case presented here is unusual in terms of age at presentation (4 days), type of infecting bacteria (GBS), rapid cyst enlargement, and prominent respiratory symptoms (previously unreported in cysts inferior to hyoid bone). Although rare, TGDCs should be included in the differential diagnosis of congenital neck masses or unexplained respiratory compromise in neonates, especially when the presentation includes positional, intermittent, or progressively worsening obstructive respiratory symptoms. As this case illustrates, infection of these cysts is common but does not always manifest with visible neck inflammation and swelling. With rapid diagnosis the potentially fatal complications of TGDCs can be avoided in neonatal patients. (C) 2009 Elsevier Ireland Ltd. All rights reserved.