Case History
A thirteen years old girl presented to ENT OPD of BPKIHS with chief complaints of shortness of breath and throat pain for 4 days. Her throat pain was continuous and associated with difficulty in swallowing both solid and liquid food. One month back she had tried to commit suicide by partial hanging. Then she was taken to a local health centre and was intubated and kept in intensive care unit for 5 days. After extubation she again developed difficulty in breathing and was tracheostomized for further 20 days. Decannulation of tube was done 7 days prior to the presentation in our OPD.
On examination, she had noisy breathing with stridor. Furthermore, she had a stomal opening on the anterior neck of size 3×1 cm2. She had increased respiratory rate with use of accessory muscle of respiration. We suspected her as a case of subglottic stenosis and admitted for further evaluation and kept under injectable antibiotics and corticosteroid. During her stay Computed Tomography (CT) scan of her neck was done and it showed ‘a soft tissue attenuating thick band like structure causing luminal narrowing extending obliquely from the right posterolateral wall of subglottic portion of larynx to the left anterolateral wall of proximal trachea- likely granuloma/ inflammatory membrane’ (Figure 1). We also did a psychiatry consultation and was diagnosed as ‘Intentional Self Harm by hanging (impulsive) with borderline personality trait ’and was started on olanzapine.