A 4-month-old infant presents with inspiratory stridor and feeding difficulties. On examination, there is a midline neck mass at the base of the tongue that moves upward on protrusion of the tongue. What is the most likely cause of the airway obstruction?
- A Vallecular cyst
- B Lingual thyroid ✓
- C Laryngomalacia
- D Vocal cord paralysis
Correct answer: B. Lingual thyroid
Explanation
A midline base-of-tongue mass that elevates on tongue protrusion is characteristic of a lingual thyroid, which results from failure of the thyroid gland to descend from the foramen cecum. This is confirmed by thyroid scintigraphy showing uptake at the tongue base and absent uptake in the normal pretracheal location. Vallecular cyst does not move with tongue protrusion. The key discriminating feature is the upward movement with tongue protrusion.
Reference: Scott-Brown's Otorhinolaryngology and Head and Neck Surgery, 8th ed.
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Written and medically reviewed by the StethoPrep medical team.