Bilateral choanal atresia diagnosed in a 3-month-old female baby: a case report

Abstract

Introduction and Importance: Bilateral choanal atresia is a congenital anomaly where a newborn baby is born with bilateral imperforate posterior nares. In most cases, the diagnosis is established immediately after birth due to respiratory distress since newborn babies are obligate nasal breathers till 6 weeks of life. Establishing the diagnosis requires a high index of suspicion as it is characterized by paradoxical cyclical cyanosis. Delayed diagnosis of bilateral choanal atresia is a rare encounter in clinical practice. We are hereby reporting a 3-month-old baby with bilateral choanal atresia, and perhaps it is the third latest diagnosed case of bilateral choanal atresia in Tanzania. Case Presentation: We present a 3-month-old female baby who was attended to at our department with a history of difficulty in breathing characterized by bilateral nasal obstruction since birth. The baby was admitted for 3 weeks due to episodes of respiratory distress after birth. She was thereafter discharged from the hospital and attended various hospitals without relief since the baby was managed as a case of adenoid hypertrophy. Clinical Discussion: The patient underwent bilateral transnasal endoscopic choanal atresia release with stenting under general anesthesia in the operating room. Postoperatively, she was kept on a nasal decongestant, a broad-spectrum antibiotic, and an analgesic. Regular suctioning was done during routine follow-up. Conclusion: Clinicians must have a high index of suspicion to establish the diagnosis of bilateral choanal atresia in newborn babies. Immediate surgical perforation of the atretic choanae with or without stenting remains to be the treatment of choice.

Unilateral Choanal Atresia in a Child With Prolonged Nasal Congestion

“…Collectively, we seek to demonstrate the importance of both misdiagnosed and undiagnosed cases, underscoring how they reflect often variable and ambiguous symptomatology. Bilateral choanal atresia is far less likely to be misdiagnosed due to its highly conspicuous features of respiratory distress immediately after birth [ 22 , 23 ]. Its counterpart, unilateral choanal atresia, often presents with unilateral nasal congestion and mucopurulent discharge [ 24 ].…”

“…The most preferred is the endoscopic transnasal approach due to the adequate exposure of the choanal plate and minimizing the risk of restenosis. Other techniques include transnasal or transpalatal resection [ 22 ].…”

“…Source: [23] The diagnosis of unilateral choanal atresia is easily distinguishable with CT [29]. Yet, most cases may go undiagnosed until later in life, particularly in teens, especially if there is no high index of suspicion in patients frequently presenting to the clinic due to persistent unilateral nasal obstruction [22]. Since CT scans are not used as routine for chronic nasal obstruction, a large proportion of cases such as these described result in a delayed diagnosis.…”