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1-Day-Old with Airway Obstruction
This case features a 1-day-old presenting with airway obstruction, ultimately diagnosed with a congenital oral teratoma.
Imaging overview:
Coronal and axial contrast-enhanced CT of the neck demonstrates a large solid and cystic mass of the oral cavity and neck with enhancing solid components, causing significant airway displacement and obstruction. Internal calcifications and fat content, when present, are helpful features for identifying teratomatous tissue, though the mixed solid and cystic morphology with enhancement is characteristic.
Clinical insight:
Congenital oral teratomas are rare germ cell tumors arising from the oral cavity or neck in fetuses and neonates. They are typically solid and cystic, often rapidly enlarging, and can cause life-threatening airway obstruction at or shortly after birth. Internal calcifications or fat, when present on imaging, strongly support the diagnosis. The solid components characteristically enhance on post-contrast imaging. When identified prenatally, these tumors are an important cause of fetal airway obstruction and may necessitate specialized delivery planning, including ex-utero intrapartum treatment (EXIT procedure), to secure the airway before umbilical cord division.
Case courtesy of Alexandra Foust, DO, Vanderbilt University Medical Center.