1/12. Anterior mediastinal masses: an anaesthetic challenge.A patient with a large anterior mediastinal mass with minimal respiratory symptoms presented for a diagnostic biopsy of the mass. A pre-operative thoracic computed tomographic scan demonstrated narrowing of the distal trachea, and right and left main stem bronchi. An awake intubation was done. Thiopentone and muscle relaxant were given and surgery commenced. High airway pressure developed and ventilation became difficult, although oxygenation remained satisfactory throughout. Anaesthetic implications are discussed. We recommend that patients with more than 50% obstruction of the airway at the level of the lower trachea and main bronchi have their femoral vessels cannulated in readiness for cardiopulmonary bypass.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/12. Thoracic lymphangiectasis presenting with chyloptysis and bronchial cast expectoration.A 70-year-old man with recurrent undiagnosed episodes of bronchial cast expectoration and pulmonary infiltrates on chest radiography for 15 years is described. The diagnosis of chyloptysis was established by chemical analysis of the bronchial aspiration. We emphasize the radiological findings of this rare observation. The CT-associated lymphangiography showed mediastinal lymphangiectasis with retrograde opacification of mediastinal and hilar lymph nodes as well as submucosal lymphatic vessels protruding into the lumen of the tracheo-bronchial tree without evidence of thoracic duct obstruction as well as a "crazy-paving appearance." Congenital incompetence of the valves of the lymphatic vessels originating from the thoracic duct is held to be the cause. Chyloptysis and pulmonary lymphatic disorder should be sought in cases of bronchial cast expectoration.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/12. Laryngo-tracheo-bronchial stenosis in a patient with primary pulmonary amyloidosis: a case report and brief review.PURPOSE: To report a case of lower respiratory tract obstruction occurring in a patient with primary pulmonary amyloidosis and discuss anesthetic management. CLINICAL FEATURES: A 53-yr-old man was referred to our institution for microlaryngoscopy and laser treatment of the larynx. He presented with a five-year history of primary laryngo-tracheo-bronchial amyloidosis and symptoms consistent with narrowing of the conducting airways. General anesthesia was induced with iv propofol 150 mg and remifentanil 50 microg. Mivacurium 20 mg provided muscle relaxation for endotracheal intubation. Following endotracheal intubation, the airway became obstructed and patient ventilation impossible. The endotracheal tube was removed and a Dedo laryngoscope inserted. Gas exchange was maintained using supraglottic jet ventilation via a distal port of the laryngoscope. Rigid bronchoscopy showed tissue partially obstructing the lumen of the lower trachea. This was removed and the airway appeared patent. At the end of the case, a further episode of lower airway obstruction occurred requiring reinsertion of the laryngoscope and resumption of jet ventilation. Extensive debridement through the bronchoscope was required before adequate ventilation could be restored. Some days later when the patient's condition deteriorated again and he required further debridement of the trachea and insertion of a tracheostomy, guide wires were positioned in the femoral vessels in the event that cardiopulmonary bypass was required for gas exchange. CONCLUSIONS: Primary laryngo-tracheo-bronchial amyloidosis is a recurrent disease, requiring repetitive surgical procedures. Airway compromise can be a persistent problem. awareness of this uncommon disease process and its presentation may serve to caution the anesthesiologist presented with this type of case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/12. Broncholithiasis: a neglected bronchial disease in this country. Illustration of three cases.A broncholith is a calcified lymph node which partially or completely erodes into the bronchial lumen. Its manifestations are non-specific and may result in life-threatening complications. In taiwan, pulmonary tuberculosis, one of the most common etiologies of broncholithiasis, is common. To our knowledge, no report on broncholithiasis can be found in literature in this country. We herein present three cases of broncholithiasis experienced in the past 11 years in Chang Gung Memorial Hospital. The presenting manifestations are obstructive pneumonia in two cases, and hemoptysis in the other one. In two of them, the broncholiths were located in the right side. Fiberoptic bronchoscopy was performed, and the stones were visible in all of them. Bronchoscopic removal of stone was successful in two cases, and the other coughed up stones spontaneously after bronchoscopies. In the absence of significant symptoms or complications, only observation is necessary. For the symptomatic borncholiths, we advocate that bronchoscopic removal is worth trying to eliminate the necessity of thoracotomy unless complications are present, which indicate surgical intervention such as massive hemoptysis, fistula formation between tracheobronchial trees and esophagus or vessels, recurrent pulmonary infection or suspicion of malignancy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/12. Bronchial compression due to stent placement in pulmonary artery in a child with congenital heart disease.Congenital heart disease, such as transposition of the great vessels (TGV), requires surgical procedures which can lead to important complications. We report on a case of bronchial obstruction following placement of a pulmonary artery stent in a 4-year-old boy who had undergone a Rastelli procedure to correct TGV, ventricular septal defect and pulmonary stenosis. There are many complications that can arise as a consequence of intravascular stents in heart surgery, as well as many causes of bronchial compression. However we have not found any report which describes bronchial compression as a direct consequence of endovascular stent.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/12. Endobronchial zygomycosis.Pulmonary zygomycosis is an uncommon opportunistic fungal infection. Diabetics have a tendency to develop major airway lesions. This can lead to invasion of the airway wall and hilar vessels with infarction and severe haemoptysis. Aggressive early surgery appears to offer the best chance of recovery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/12. Clinical spectrum of infantile lobar emphysema.Infantile lobar emphysema in an uncommon disease affecting newborns and infants with varying degrees of respiratory distress, evidence of lobar overaeration, mediastinal shift, and herniation. Congenital malformations of the bronchi and alveoli and extrinsic compression by vessels and cysts account for less than 50% of these cases. All segments of the upper and middle lobe may be involved, but the major overexpansion occurs in the anterior segment. Respiratory distress may be absent, mild, or severe, and the condition may be acutely progressive, acutely reverisble, chronic, or recurrent. This symptom complex is the result of multiple factors requiring investigation prior to definitive operation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/12. Endoscopic observation of peripheral airway lesions.Peripheral airways of 2 mm or less in diameter were observed in 142 patients by means of an ultrathin bronchofiberscope measuring 1.8 mm in outside diameter. On the basis of the observed and photographed endoscopic findings, an endoscopic classification of peripheral airway lesions was proposed. The endoscopic findings showed changes in the bronchial wall consisting of reddening, pallor, absence of mucosal luster, edema, engorgement of blood vessels, irregular mucosal surface, and elevated mucosa. In the lumen, stenosis, obstruction, ectasis, and deformation due to pressure were recognized, in addition to excessive secretion and pigmentation as morphologic abnormalities or abnormal findings at bifurcation.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/12. Self-expanding tracheobronchial stents using flexible bronchoscopy. Preliminary clinical experience.Endoscopic insertion of tracheobronchial stents is indicated to achieve patency of the airway in case of malignant or benign obstructing lesions. Until now, the placement of prostheses has required a rigid bronchoscope with specially designed insertion instruments. Self-expanding stents are currently used to treat stenoses of different hollow organs (vessels, urinary tract, gastrointestinal tract, bile duct, respiratory tract). We report the first case of a self-expanding stent implanted in the trachea and right main stem bronchus using flexible videobronchoscope under local anesthesia. The procedure was easy, safe, effective, and well tolerated. No complications occurred.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/12. Bronchovascular mucormycosis: an urgent surgical problem.The case of a 70-year-old male with lymphoblastic leukemia is reviewed, who presented the rare and almost always fatal complication of pulmonary mucormycosis, but who was treated satisfactorily with amphotericin b and surgery. The risk of massive hemoptysis in the course of mucormycosis that invades the lung vessels, makes us believe that surgery is an essential part of the management of this disease. It is suggested that the patient be operated as soon as the diagnosis is obtained, as we did in our case, to avoid other risks in combined management with amphotericin b.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
| | Next -> |