Background: Functional causes of upper airway obstruction have focused prim
arily on psychogenic strider associated with paradoxical vocal cord dysfunc
tion. Angioedema can involve upper airway structures and be life-threatenin
g.
Case Report: We report a 12-year-old female with upper airway obstruction f
rom posterior tongue swelling which was determined to be a conversion react
ion.
Methods & Results: A lateral neck film revealed severe tongue swelling. Exa
mination revealed a calm, cooperative patient in no distress but exhibiting
inspiratory and expiratory strider. A computed tomography scan revealed so
ft tissue fullness at the base of the tongue without associated lymphadenop
athy. Laboratory evaluation was normal. With anesthetic induction in the op
erating room, there was complete relaxation of the upper airway with no evi
dence of tongue swelling, mass, or other abnormality. Following tongue biop
sy, she had no reoccurrence of the tongue mass.
Conclusion: This case represents a childhood conversion reaction of functio
nal airway obstruction where tongue manipulation simulated tongue swelling
radiographically consistent with angioedema.