Clinical Practice and Cases in Emergency Medicine

Introduction: Acquired idiopathic laryngomalacia causing dynamic airway collapse is rare in adolescents and may be overlooked because it mimics more common causes of acute dyspnoea and stridor in the emergency department (ED). Airway point-of-care ultrasound (POCUS) provides a rapid, non-invasive means to visualize dynamic supraglottic obstruction when laryngoscopy is not immediately feasible or tolerated.​

Case Report: A 13-year-old boy presented with sudden-onset respiratory distress and dyspnoea that worsened on lying flat and improved when sitting upright, without history of fever, trauma, allergy, or foreign body aspiration, and with similar prior self-limiting episodes. He was anxious with nasal flaring, subcostal retractions, tachypnoea, tachycardia, distended neck veins, and a squeaky tracheal inspiratory sound, yet he maintained normal oxygen saturation with equal air entry on auscultation. Airway POCUS showed abnormal downward displacement of the epiglottis with every distressful inspiration, indicating dynamic airway collapse, and non-contrast computed tomography of the neck demonstrated a heart-shaped, mid-epiglottis deformity consistent with acquired idiopathic laryngomalacia. The patient was given supportive treatment to reduce mucosal oedema, resulting in gradual symptom resolution, and after two days of observation and otorhinolaryngology evaluation he was discharged in stable condition.​

Conclusion: Acquired idiopathic laryngomalacia should be considered in adolescents with unexplained positional respiratory distress and discordant findings of significant work of breathing but preserved oxygenation. Airway point-of-care ultrasound can delineate real-time dynamic laryngeal abnormalities at the bedside, thereby facilitating early diagnosis and appropriate management of dynamic airway collapse in the emergency department.