1/7. thyroid gland hematoma after blunt cervical trauma.Thyroid hematoma is a rare cause of airway obstruction in victims of blunt trauma. The case of a 34-year-old woman who developed orthopnea after a low-energy motor vehicle accident is described. Presenting greater than 24 hours after her accident, the patient noted dysphagia, tracheal deviation, and postural dyspnea. The diagnosis of thyroid gland hematoma was made with a combination of fiberoptic laryngoscopy, cervical computed tomography, and great vessel and carotid angiography. Invasive airway management was not required. The patient underwent a total thyroidectomy and recovered without complications.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/7. Tracheocarotid artery fistula infected with methicillin-resistant staphylococcus aureus.Massive life-threatening haemorrhage from a fistula between the trachea and a major blood vessel of the neck is a rare complication of the tracheostomy procedure, well-recognized by anaesthetists and otolaryngologists. Although the lesion is likely to be encountered at autopsy, it is not described in histopathological literature. The possible causes are discussed together with the macroscopic and microscopic appearances of the lesion. Suitable procedures for its identification and for obtaining appropriate histopathological blocks are suggested. Presence of methicillin-resistant staphylococcus aureus (MRSA) has not been documented before and might have contributed to the genesis of the fistula in this case.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/7. trachea--innominate artery fistula following tracheostomy. Successful repair using an innominate vein graft.This report discusses the first recorded patient in whom a trachea--innominate artery fistula after tracheostomy was treated successfully by resection of the eroded segment of artery followed by graft replacement using the patient's left innominate vein. The mechanism of vessel erosion and its prevention are discussed. Also, suitable methods are presented for obtaining temporary control of the severe hemorrhage associated with a tracheoarterial fistula while simultaneously maintaining an adequate airway.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/7. Aberrant right subclavian artery: varied presentations and management options.Although an aberrant right subclavian artery arising from the proximal portion of the descending thoracic aorta is the most common aortic arch anomaly, few patients have clinical symptoms directly attributable to it. When symptoms do occur they are usually causally related to aneurysmal or occlusive sequelae of atherosclerotic disease of the anomalous vessel. More unusual manifestations peculiar to the anomalous artery include aneurysmal degeneration of the origin of the vessel from the aortic arch, with its inherent risk of rupture, or symptoms of compression of the trachea or more commonly the esophagus by the anomalous vessel as it traverses the superior mediastinum. In patients with symptoms a variety of operative approaches and management strategies have been used. Our recent experience with treatment of two patients with clinical symptoms caused by an aberrant right subclavian artery illustrate the varied surgical options and prompted a review of the surgical management of this unusual anomaly.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
5/7. Management of trachea--innominate artery fistula.The case histories of three patients with trachea-innominate artery fistula are presented. Low tracheostomy was the etiologic factor producing the fistula in two patients. In both cases, the neck was hyperextended by placing a large roll behind the patient's shoulders and thereby elevating the trachea out of the mediastinum. In one patient a balloon cuff eroded the innominate artery. Management of these patients includes control of hemorrhage by cuff overinflation and/or by endotracheal intubation and packing of the tracheostomy site. The best surgical approach is via a right anterior thoracotomy and a separate neck incision to isolate the blood vessels involved. Median sternotomy should be avoided to prevent mediastinal infection and sternal dehiscence. Carotid stump pressures are a useful guide to determine the efficacy of innominate artery ligation. One patient was saved and is a long-term survivor.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/7. Tracheo-carotid artery erosion following endotracheal intubation.A case of tracheo-carotid artery erosion in a patient who required only endotracheal intubation is presented. This appears to be the first case reported in the world literature that was not associated with a tracheostomy. Etiologic factors leading to this complication include direct pressure from the tube tip, abrasions during intubation, mucosal damage from cuffs, and CPAP, even over a short time. Selection of an endotracheal tube with a high-compliance, low-pressure cuff, careful intracuff pressure monitoring, prevention of infection and hypotension, and improvement in the patient's nutritional and immunologic status will help to prevent this complication. Any patient bleeding more than 10 ml without cause should be suspected of having this complication. Rapid treatment is necessary for survival. patients should be intubated and the cuff inflated. Bronchoscopic examination should be done in the operating room under general anesthesia with neck and chest prepped and draped. Median sternotomy or possibly right anterior thoracotomy is recommended. Resection of involved vessels has been successful.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/7. A full-thickness chondrocutaneous flap from the auricular concha for repair of tracheal defects.A free full-thickness chondrocutaneous flap from the auricular concha for the repair of large tracheal defects was transferred successfully. The flap is based on the superficial temporal vessels (reversed flow) and the posterior auricular vessels. The advantages of this flap for the repair of tracheal defects are (1) its dissection is easy, (2) thin components of the flap provide a wide postoperative airway, (3) the structure of the reconstructed trachea is made firm by the conchal cartilage with vascularization, (4) the highly vascularized cartilage results in less resorption than a free cartilage graft, (5) the donor site can be repaired easily and is concealed by the remnant auricle, and (6) a long arterial pedicle (reversed flow) can be obtained. The disadvantages are (1) there may be temporary postoperative congestion of the flap, (2) postoperative narrowing of the auriculocephalic sulcus may occur, and (3) a short venous pedicle often requires a vein graft.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |