To report a rare case of Type IV laryngo-tracheo-esophageal cleft (LTEC) in a preterm neonate and to document the challenges in antenatal diagnosis and management.
Approach:
Case Presentation: A preterm neonate born at 34 + 1 weeks’ gestation from a monochorionic diamniotic twin pregnancy was evaluated. Antenatal ultrasound detected a large microcystic congenital pulmonary airway malformation (CPAM) with mediastinal shift, absent gastric bubble, and suspected esophageal pouch.
Diagnostic Procedures: Direct laryngoscopy and intubation revealed a common tracheoesophageal lumen; flexible bronchoscopy confirmed a Type IV LTEC with absent posterior tracheal wall extending to the carina and communicating with the oesophagus. CT thorax demonstrated significant anomalies.
Management Decision: Surgical repair was deemed high risk due to multiple factors, leading to a decision for palliative care after multidisciplinary counseling.
Key Findings:
Type IV LTEC is a rare congenital anomaly with high mortality and morbidity.
Antenatal imaging has limitations in detecting posterior laryngeal and tracheoesophageal structures.
The presence of associated foregut anomalies may indicate the likelihood of airway malformations.
Interpretation:
This case illustrates the diagnostic challenges of antenatal identification of Type IV LTEC, particularly in the presence of other foregut anomalies.
Limitations:
Antenatal imaging may not reliably detect severe airway malformations.
Limited reports of Type IV LTEC from Southeast Asia.
Conclusion:
This case highlights the importance of early bronchoscopy for airway evaluation and the role of palliative care when surgical options pose significant risks.
Review of 88 studies found AI systems achieved high accuracy for identifying abnormal voices, but performance declined among higher-level laryngeal disorder classifications.
