1/15. Intemittent obstruction of the upper airway during sleep causing profound hypoxaemia. A neglected mechanism exacerbating chronic respiratory failure.An obese patient with a ten year history of respiratory failure presented with insomnia and marked daytime somnolence. Respriatory failure had been attributed to obesity, respiratory centre insensitivity to carbon dioxide, and to diffuse airways obstruction. To investigate the possible role of episodic apnoea with frequent nocturnal arousals, continous recordings were obtained during sleep of arterial oxygen saturation, oesophageal pressure and the motions of the rib-cage and abdomen/diaphragm. Repeated episodes of hypoventilation and profound hypoxaemia were found which were due to intermittent obstruction of the upper airway rather than to cessation of breathing efforts. During the episodes of hypoxaemia, values of arterial O2 tension fell to as low as 24 mmHg. Episodic hypoxaemia was relieved but not abolished, by the use of a collar, designed to hold the mandible forward. Previous reports indicated that recognition of intermittent obstruction of the upper airway during sleep and treatment by a permanent tracheostomy, resulted in a significant long-term imporvement of pulmonary and cardiac function and relief of insomnia and day-time somnolence. When tracheostomy is inadvisable, as in the present patient, it is hoped that similar long-term benefits will result from a supportive collar.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/15. Spiral CT versus MRI in neonatal airway evaluation.magnetic resonance imaging has become the standard means of imaging pediatric airway obstruction due to vascular anomalies. However, magnetic resonance imaging requires a long acquisition time and is prone to motion artifacts. The development of spiral or helical computed tomography provides an alternative imaging modality for evaluating pediatric airway obstruction. We present the case of a neonate with a double aortic arch which initially was not identified on magnetic resonance imaging but was visualized with spiral computed tomography. If suspicion of an intra-thoracic abnormality is high, spiral computed tomography may be a useful adjunct or replacement to magnetic resonance imaging.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
3/15. Abnormal movement of the arytenoid region as a cause of upper airway obstruction.A 75 year old woman presented with a three week history of severe dyspnoea and cough. auscultation and spirometry suggested extrathoracic inspiratory airway obstruction, and bronchoscopy showed abnormal motion of the arytenoid region (supraglottic area), causing upper airway obstruction only during forced inspiratory efforts. Sedatives improved the symptoms within a week. It is suggested that reversible malfunction of the arytenoid region can be responsible for upper airway obstruction.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/15. Paradoxical vocal cord motion: an often misdiagnosed cause of postoperative stridor.This conference reports a case of acute functional airway obstruction occurring in the postoperative anesthesia care unit, which was diagnosed by fiberoptic laryngoscopy and successfully treated with intravenous midazolam after other more common causes of stridor were ruled out. The presentation, etiology, diagnosis, and treatment of paradoxical vocal cord motion as it relates to the care of the postoperative patient are discussed.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
5/15. Virtual bronchoscopy in patients with central endobronchial stenosing lesions. Technique optimisation with single slice spiral CT.PURPOSE: To describe an original protocol for single slice spiral Computed tomography (CT) virtual bronchoscopy in the evaluation of patients with central airway stenoses and compare the results with fibreoptic bronchoscopy. MATERIALS AND methods: Ten patients (4 female and 6 male; age range 22-60 years; mean age 44 years) with endobronchial disease diagnosed by fibreoptic bronchoscopy (8 malignant tumours, 1 benign tumour and 1 fibroid stenosis) underwent virtual bronchoscopy with single slice spiral CT. A panoramic spiral CT scan of the whole chest was first obtained. Once the area of interest had been identified, a new contrast enhanced scan was performed, from bottom to top, with the following parameters: 2 mm slice thickness, 1 mm reconstruction index, 1.3 pitch, 120 Kvp, 80 mAs. Virtual bronchoscopy was generated with an upper threshold of -500 HU from the cross-sectional images of the second scan on a dedicated workstation. Axial, multiplanar reformations (MPR), and virtual endoscopy simulation were simultaneously visualised. Virtual CT bronchoscopy findings were compared with those of fibreoptic bronchoscopy. RESULTS: The protocol we used to perform single slice spiral CT virtual bronchoscopy enabled us to obtain virtual bronchoscopy images that correlated well with fibreoptic bronchoscopy findings in all cases, as well as allowing the visualization of the airways beyond the stenoses. Information about tissues surrounding the tracheobronchial tree was also available from axial and MPR images. Only in 1 case were motion artefacts observed. CONCLUSIONS: The set of the most appropriate parameters for performing virtual bronchoscopy by single slice spiral CT has not yet been standardized. In our opinion the appropriate selection of the protocol to adequately realize virtual bronchoscopic images is crucial when using CT devices such as the above, so as to achieve the correct balance between the quality of image definition and exposure dose.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/15. Fourteen cases of imposed upper airway obstruction.Imposed upper airway obstruction was diagnosed as the cause of recurrent and severe cyanotic episodes in 14 patients. Episodes started between 0.8 and 33 months of age (median 1.4) and occurred over a period of 0.8 to 20 months (median 3.5). diagnosis was made by covert video surveillance, instituted after either (a) the observation that episodes began only in the presence of one person, or (b) characteristic findings on physiological recordings, lasting between 12 hours and three weeks, performed in hospital or at home. Surveillance was undertaken for between 15 minutes and 12 days (median 24 hours) and resulted in safety for the patient and psychiatric assessment of the parent: mother (n = 12), father (n = 1), and grandmother (n = 1). These revealed histories of sexual, physical, or emotional abuse (n = 11), self harm (n = 9), factitious illness (n = 7), eating disorder (n = 10), and previous involvement with a psychiatrist (n = 7). Management of the abusing parents is complex, but recognition of their psychosocial characteristics may allow earlier diagnosis. Imposed upper airway obstruction should be considered and excluded by physiological recordings in any infant or young child with recurrent cyanotic episodes. If physiological recordings fail to substantiate a natural cause for episodes, covert video surveillance may be essential to protect the child from further injury or death.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/15. Paradoxical vocal cord motion: an unusual cause of stridor.Stridor due to obstructive causes is relatively common. Functional airway obstruction with paradoxical vocal cord motion is uncommon. Only 12 cases have been reported in the literature in the past 15 years. The majority were young female patients. We have recently encountered two cases. Lack of awareness of this condition caused several problems in management.- - - - - - - - - - ranking = 5keywords = motion (Clic here for more details about this article) |
8/15. Adenotonsillar hypertrophy and cor pulmonale: clinical and echocardiographic correlation.It is well recognized that upper airways obstruction by adenotonsillar hypertrophy can lead to cor pulmonale, but delays in diagnosis still occur, leading to an appreciable morbidity and even occasional mortality. In the case presented, echocardiographic recognition of right ventricular enlargement and abnormal pulmonary valve motion served to complement and confirm the clinical diagnosis. Following surgical relief of the airways obstruction, the echocardiographic examination usefully documented the regression in right ventricular size and the return to normality of pulmonary valve motion.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
9/15. Stridor in an adult. An unusual presentation of functional origin.A 34-year-old woman with a recent history of a influenza-like illness and signs of bronchopneumonia presented with many of the features of acute epiglottitis, a condition which still carries a high mortality in adults. Urgent laryngoscopy and bronchoscopy under inhalational anaesthesia were negative. The results of arterial blood gases, taken when stridor was at its worst, revealed marked hypocapnia and respiratory alkalosis. We conclude that the resultant acute reduction of serum ionised calcium produced stridor as a result of tetany of the vocal cords. Similar cases from the literature and the role of emotional factors in the aetiology are discussed.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/15. Hysterical stridor: a benign cause of upper airway obstruction.We present the cases of three patients with stridor that resolved spontaneously. Paradoxical vocal cord motion was documented in one patient. Normal vocal cord motion was present in the other two patients, but stridor had resolved in both cases. Many different terms have been used to describe this entity in the literature. Emergency physicians must recognize the subtle signs of hysterical stridor. Once more serious etiologies are ruled out, sedation and reassurance instead of aggressive airway intervention are required for this benign condition.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
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