1/12. Surgical emphysema: a rare presentation of foreign body inhalation.An 11-year-old girl with an almond lodging in the tracheobronchial tree is described. She presented with an uncommon symptom of subcutaneous emphysema The x-ray revealed left-sided pneumothorax and pneumomediastinum. Intercostal drain was inserted, but she developed respiratory failure and was ventilated. After initial stabilization for 60 hours, she deteriorated again and her x-ray revealed right-sided collapse. After removal of the foreign body, she was discharged but presented again with stridor necessitating tracheostomy. tracheal stenosis was found and required end-to-end anastomosis. The authors feel that, while foreign bodies are uncommon in this age group with emphysema as a rarer manifestation, this cause should be kept in mind, even in the absence of forthcoming history. A high index of suspicion for tracheobronchial foreign body is required in atypical presentations of acute pediatric respiratory distress.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/12. Arterial to end-tidal CO2 laparoscopic gradient reversal during pheochromocytoma resection.PURPOSE: We report the development of severe intraoperative hypercarbia and a pronounced arterial to end-tidal gradient reversal during laparoscopic pheochromocytoma resection. Although complex physiologic mechanisms may be responsible for this finding, anatomic alterations such as a direct communication between a capnoperitoneum and/or capnothorax and the airways resulting from prior pathology and the type of procedure should also be considered. CLINICAL FEATURES: During anesthesia for laparoscopic pheochromocytoma removal we noticed an abrupt, extensive increase of the end-tidal CO(2) accompanied by a change of the capnographic CO(2) tracing and reversal of the normal arterial-to-end-tidal gradient. These changes consistently disappeared by intermittent deflation of the abdomen and at the end of surgery. A chest x-ray revealed a right-sided loculated pneumothorax with pleural thickening. Peritoneo-thoracic CO(2) tracking and pleural scaring with pulmonary adhesions resulting in a unidirectional communication between the pleural space and airways may best explain the chest x-ray and clinical findings. CONCLUSION: Severe intraoperative hypercarbia and arterial to end-tidal CO(2) gradient reversal represents an intraoperative challenge. The possibility of a direct communication between the pleural space and the bronchial tree should be considered when other etiologies have been excluded. Simple maneuvers such as abdominal de- and re-inflation and analysis of the end-tidal capnographic tracing might aid in the differential diagnosis and management.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/12. Pneumothorax complicating small-bore feeding tube placement.Small-bore Silastic feeding tubes are being used with increasing frequency for short- and long-term enteral hyperalimentation. We present three cases where these flexible tubes were passed into the tracheobronchial tree and then out into the pleural space. The result in each case was a pneumothorax or hydropneumothorax. These cases were collected at one community hospital over a 6-month period. A review of the current literature reveals reports of 10 similar cases. We conclude that, although the exact incidence of pleural complications of small-bore feeding tubes is unknown, it is not insignificant. The traditional methods of assessing proper nasogastric tube placement are inadequate when applied to these small tubes. Only a chest roentgenogram can assure placement in the stomach. education of hospital staff on methods to avoid malposition of feeding tubes has resulted in an absence of pulmonary complications over a subsequent 1-year period.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/12. Necrotizing tracheobronchitis: complication of mechanical ventilation in an adult.A 51-year-old woman had localized interstitial pneumonia that rapidly progressed to involve all lung fields. After 9 days of conventional mechanical ventilation, pneumothorax developed in the presence of an obstruction of the right main bronchus. bronchoscopy and endobronchial biopsies revealed NTB involving the tracheobronchial tree distal to the tip of the endotracheal tube, with complete obstruction of the right main bronchus by hard, eschar-like material. Tracheal mucosa proximal to the tip of the endotracheal tube was normal. Subsequent bronchoscopy, 20 days later, showed marked resolution of NTB. Though a frequent complication of mechanical ventilation in the neonate, NTB as a complication of conventional mechanical ventilation has not previously been recognized in an adult. Necrotizing tracheobronchitis should be suspected in adults who have had mechanical ventilation and who are experiencing ventilatory difficulties, after routine problems have been treated or excluded.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/12. Preventing postoperative complications in the adult cystic fibrosis patient.Herein we report on a 27-year-old cystic fibrosis (CF) patient who developed bronchospasm, secretory plugging of the trachea, and pneumothorax following general endotracheal anesthesia for intranasal polypectomy and bilateral Caldwell-Luc procedures at an adult facility. Intranasal polypectomy and paranasal sinus procedures are the most common surgical procedures performed on cystic fibrosis patients, making the otolaryngologist a frequent member of the cystic fibrosis team [8]. As survival improves, the pediatric otolaryngologist will find himself following CF patients into their 20's and 30's. adult care facilities may not be as familiar with these patients as the surgeon would like. The otolaryngologist's familiarity with the unique perioperative requirements of the CF patient can prove invaluable in such a setting. Preoperative assessment should identify any acute pulmonary changes, assess nutritional status, assure good control of blood glucose levels, and rule out clotting abnormalities. Good perioperative hydration and meticulous attention to pulmonary toilet are of foremost importance in the surgical care of the cystic fibrosis patient. Chest physiotherapy and suctioning of the tracheobronchial tree should precede arousal from anesthesia and extubation. By insisting on appropriate anesthetic and perioperative care, the knowledgeable otolaryngologist may circumvent potential postoperative complications in the cystic fibrosis patient.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/12. Iatrogenic bronchopleural fistula caused by feeding tube insertion.Nutritional supplements administered through flexible small caliber feeding tubes are an increasingly popular substitute for parenteral hyperalimentation. Small and large caliber nasogastric tubes can inadvertently pass into the tracheobronchial tree, even in the presence of an endotracheal tube with an inflated cuff. We report three patients who had small caliber feeding tubes passed through the tracheobronchial tree perforating into the pleural space. Potential complications include immediate or delayed pneumothorax, tension pneumothorax, hydropneumothorax, and empyema. Prompt post-insertion chest radiography is required to verify correct placement of small caliber feeding tubes.- - - - - - - - - - ranking = 2keywords = tree (Clic here for more details about this article) |
7/12. Pneumothorax following attempted nasogastric intubation for nutritional support.Nasogastric intubation is a routine procedure, performed daily by both medical and nursing staff. It is a simple procedure, but not without complications which can be life threatening. We present an unusual, life threatening complication which occurred when nasogastric intubation using a no. 8 polyurethane tube with its metal stilet resulted in a pneumothorax after intubation of the endotracheal tree in the presence of a cuffed endotracheal tube. We emphasize that the presence of a cuffed endotracheal tube should not be considered a safeguard against pulmonary intubation during nasogastric placement of a feeding catheter.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/12. Percutaneous lung biopsy. Management of tracheobronchial haemorrhage.A case is reported in which percutaneous lung biopsy was followed by haemorrhage into the tracheobronchial tree. Hypoxia followed, precipitating a cardiac arrest. The haemorrhage was isolated by the insertion of a double-lumen tube. Complications arising from this method of biopsy are reviewed and the measures necessary to control the potentially fatal problems are discussed.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/12. Traumatic bronchial rupture.Traumatic injury to the tracheobronchial tree requires prompt, accurate diagnosis for optimum surgical treatment. The radiologist is in a pivotal position either to suggest this diagnosis or to initiate further investigation to establish it. Three cases of traumatic bronchial rupture illustrate the spectrum of radiologic findings and document the value of tomography in confirming this diagnosis.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
10/12. Complications of attempted central venous injections performed by drug abusers.Intravenous abuse of drugs has become an integral part of various subcultures within American communities. The continued use of peripheral veins in this setting eventually leads to their obliteration through a sclerotic or infectious process. Inveterate drug abusers often turn to using larger veins in the groin and neck. Some real or imagined technical aspects of subclavian and internal jugular venous injections are well known to drug abusers in many locales. Undoubtedly as these skills are passed from one user to another, the fine points of anatomy and needle positioning are distorted with resultant mishaps. Twelve patients have been seen with complications arising from attempted supra- or subclavicular injections of drugs in the "street" setting: unilateral pneumothorax, six cases; bilateral pneumothorax, one case; mycotic subclavian carotid artery aneurysm, two cases; neck abscesses, three cases (one also listed under pneumothorax); and paraplegia, one case. Since this type of injury may occur in greater frequency due to increasing drug abuse, recognition and proper treatment of these potentially life-threatening problems may prevent mortality and reduce morbidity.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
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