Cases reported "Tracheal Stenosis"

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1/289. Localised upper airway obstruction in a patient with acquired immunodeficiency syndrome.

    We describe a case of rapidly progressive upper airway obstruction due to tracheal Pseudomonas abscesses in a patient with acquired immunodeficiency syndrome. The case highlights the aggressive nature of pseudomonas infections and the difficulty of eradicating this organism in patients infected with the human immunodeficiency virus.
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ranking = 1
keywords = airway obstruction, airway, obstruction
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2/289. Percutaneous dilation of tracheal stenosis.

    A high-grade complex tracheal stenosis distal to a tracheostomy tube occurred in a patient with a chronic vegetative state. The stenosis was easily and rapidly dilated at bedside using commercially available percutaneous tracheostomy kit dilators. Following tracheal dilation, a larger tracheostomy tube was inserted, resulting in the splinting of the stenotic area. To my knowledge, this is the first report of such a bedside technique for the dilation of a tracheal stenosis through a tracheostomy. This technique may provide a temporary relief from tracheal obstruction as long as the stenosis is within the reach of the dilator.
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ranking = 0.0073768760337716
keywords = obstruction
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3/289. 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.
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ranking = 0.074020706826395
keywords = airway, obstruction
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4/289. life-threatening airway obstruction caused by a retropharyngeal haematoma.

    We present the case of a 68-year-old woman who had a large cervicomediastinal haematoma that caused life-threatening airway obstruction. Retropharyngeal haematoma may occur in any age group and following a variety of causes. Retropharyngeal haematomas must be considered as a cause of airway obstruction following common injuries such as blunt cervical trauma or internal jugular vein cannulation. A high index of suspicion and early lateral neck X-ray is essential for safe management of this rare but potentially life-threatening injury.
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ranking = 1.2
keywords = airway obstruction, airway, obstruction
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5/289. Management of a pregnant patient with airway obstruction secondary to goitre.

    A case of airway obstruction in advanced pregnancy is presented. The patient was successfully managed with an awake fibreoptic intubation performed orally followed by a caesarean section and thyroidectomy as a combined procedure. On resection, a thyroid gland weighing 370 g was removed. The patient made an uneventful recovery.
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ranking = 1
keywords = airway obstruction, airway, obstruction
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6/289. Postoperative airway stenosis and stent therapy in carinal reconstruction for lung cancer.

    A 48-year-old male had adenocarcinoma of the right upper lung lobe that invaded the lower trachea. The right upper lobe, the carina, and 5 rings of the lower trachea were resected. The carina was reconstructed using end-to-end anastomosis between the trachea and right intermediate bronchus, with the left main bronchus anastomosed to the side wall of the intermediate bronchus. Two months after surgery, the right intermediate bronchus developed bronchomalacia and the tracheal anastomosis granulatory stenosis. bronchomalacia was treated with 2 expandable metallic stents, and granulatory stenosis with a Dumon stent. Although the silicone stent successfully dilated the granulatory stenosis, the metallic stents caused delayed glanulatory stenosis. We concluded that a metallic stent is not desirable for treating postreconstructive airway stenosis including bronchomalacia, whereas a Dumon stent may be effective.
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ranking = 0.16660957698156
keywords = airway
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7/289. Lingeous conjunctivitis with tracheal obstruction. A case report, with light and electron microscopy findings.

    A white male infant of 1 year had unilateral membranous conjunctivitis and severe laryngotracheobronchitis which required tracheostomy. Cultures from eye and throat swabs and of fluid suctioned through the tracheostomy grew many organisms, including H. influenzae, adenovirus type 3, and candida species, but he had no specific immunologic disturbance. Ligneous conjunctivitis was diagnosed. The infant's general condition responded slowly to intensive therapy but the membrane continued to slough off the regrow. The excised membrane contained massive subepithelial deposits of eosinophilic material and a moderately vascular chronic inflammatory-cell infiltrate with numerous mast cells in the perivascular spaces and the hyaline membrane. The conjunctivitis cleared when treated with topical sodium cromoglycate (Intal), a known inhibitor of mediator release from mast-cell granules. The success of Intal therapy in this case supports the theory that mast cells are involved in the pathogenesis of ligneous conjunctivitis.
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ranking = 0.029507504135086
keywords = obstruction
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8/289. airway management and transesophageal echocardiographic monitoring for pulmonary artery sling.

    pulmonary artery sling is an uncommon vascular anomaly and can be life threatening when it causes tracheal compression. We report on a 14-day-old boy who presented with respiratory distress soon after birth. A series of examinations showed tracheal stenosis due to a pulmonary artery sling. Surgery was performed with the aid of cardiopulmonary bypass. The external compression and intrisic stenosis could not be resolved by vascular surgery because of tracheal malacia and a complete tracheal ring. We recommend cutting extra holes 1 to 2 cm from the distal end of the endotracheal tube for endobronchial intubation. The airway obstruction was resolved successfully with a custom-made endobronchial tube. However, the patient died of pneumomediastinum and pneumothorax induced by barotrauma, on the fourth postoperative day.
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ranking = 0.2
keywords = airway obstruction, airway, obstruction
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9/289. Perioperative extracorporeal membrane oxygenation for tracheal reconstruction in congenital tracheal stenosis.

    The management of a critical airway in infants and toddlers with congenital tracheal stenosis (CTS) continues to be an enormous challenge to the surgeon. Until recently, this condition often proved fatal. Improvements in surgical techniques, anesthetic management, and postoperative critical care have resulted in successful outcomes in children not long ago considered untreatable. However, issues such as the best operative approach and the optimal perioperative management are still unresolved. The diagnosis of CTS, often delayed, must be considered in any infant with stridor, wheezing, cyanosis, or recurrent episodes of pneumonia. Associated anomalies are the rule, including frequently vascular rings and rarely pulmonary agenesis. These defects can be repaired with conventional ventilatory support under cardiopulmonary bypass, or using extracorporeal membrane oxygenation (ECMO). We report our experience in which ECMO was used to support two patients with CTS during the perioperative period. ECMO proved to be both safe and practical, allowing unrushed, precise repair of the tracheal stenosis and providing brief postoperative support. Perioperative outcomes were excellent, although one of our patients died months after the repair. A review of the literature and our experience in which ECMO was used to provide cardiopulmonary support during repair of CTS showed uniformly successful perioperative outcomes.
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ranking = 0.033321915396311
keywords = airway
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10/289. An unusual cause of tracheal stenosis.

    PURPOSE: To report a large chronic tracheal foreign body, causing tracheal stenosis in an 11-yr-old girl. CLINICAL FEATURES: The history was suggestive of obstructive airways disease with secondary bronchiectasis. Physical findings were crepitations and rhonchi all over the chest. blood gases were normal. Chest X-ray showed bronchiectasis and a ventilation perfusion scan identified a tracheo-esophageal fistula. During anesthesia to confirm this, intubation and ventilation were difficult because of tracheal stenosis. The hypoventilation resulted in severe hypercarbia and acidosis. A subsequent CT scan showed a stenosis of 2 mm diameter and 1 cm length in the middle third of trachea, bronchiectasis, and an air filled pocket between the trachea and esophagus. PFT showed a severe obstruction. Antitubercular treatment which was started on the presumptive diagnosis of tuberculous stenosis and tracheoesophageal fistula caused a delay with deterioration of patient from intermittent dyspnea to orthopnea with severe hypecarbia and acidosis. The anesthetic management of the tracheal reconstruction was difficult due to her moribund condition even after medical treatment, the short length of the trachea above the obstruction, its severity and lack of resources for alternative techniques. A large foreign body was found lying obliquely in the trachea dividing it into an anterior narrow airway mimicking a stenosed trachea, and a wider posterior blind passage. CONCLUSION: The anesthetic consequences were peculiar to the unexpected etiology of the stenosis and poor general condition of the patient. Minor details like the tracheal tube bevel and ventilatory pattern became vitally important.
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ranking = 0.081397582860166
keywords = airway, obstruction
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