2025 Volume 61 Issue 2 Pages 384-388
The patient was a newborn boy. Fetal ascites was detected at 18 weeks of gestation, then it resolved spontaneously. At 35 weeks of gestation, the mother was admitted to our hospital due to a fetal transient bradycardia. Subsequently, an emergency cesarean section was performed at 37 weeks and 3 days of gestation because of non-reassuring fetal status. At birth, the infant exhibited gasping and bag-mask ventilation was initiated without success. The vocal cord was not observed, and the intubation was unsuccessful. Effective ventilation was finally achieved 30 minutes after birth with an emergency tracheostomy performed by pediatric surgeons. On day 5, the subglottic lumen could not be identified with a laryngeal fiberscope and the patient was diagnosed with congenital laryngeal obstruction. Further evaluations, including swallow esophagography and cervicothoracic contrast CT scan, revealed no evidence of tracheoesophageal fistulas. After stable spontaneous breathing was confirmed, the patient was discharged on day 56. At 10 months of age, a diagnosis of congenital laryngeal web was made based on laryngeal fiberscope, which revealed a slight opening in the glottis and contraction of the false vocal cords. Despite the lack of prenatal diagnosis, rapid collaboration with pediatric surgery teams led to the patient’s survival and discharge without major comorbidity. The characteristic imaging findings of congenital high airway obstruction syndrome（CHAOS）can sometimes resolve spontaneously. In cases of transient fetal ascites, the possibility of CHAOS should be considered.
