Cases reported "Tracheal Stenosis"

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1/29. Stridor in a 6-week-old infant caused by right aortic arch with aberrant left subclavian artery.

    BACKGROUND: Persistent infant stridor, seal-like cough, and difficulty feeding can be the initial signs of right aortic arch with an aberrant left subclavian artery. This congenital cardiovascular abnormality results in the development of a vascular ring that encircles the trachea and esophagus. methods: A case report is presented that describes the evaluation and care of a 6-week-old male infant whose condition was diagnosed as right aortic arch and aberrant left subclavian artery after he was brought to the family practice clinic with a history of persistent stridor. This case report involved a patient seen in the author's outpatient clinic during a well-child check. Data were obtained from the patient's medical record and review of his radiologic diagnostic tests. medline and Index Medicus literature searches were conducted for the years 1966 to the present, using the key words "stridor" and "vascular ring," with cross-references for earlier articles. RESULTS AND CONCLUSIONS: Persistent or recurrent stridor associated with feeding difficulties should prompt an investigation for a vascular ring. In general, an anteroposterior and lateral neck radiograph and a posteroanterior and lateral chest radiograph are usually the initial diagnostic tests to evaluate stridor. Persistent stridor and new-onset regurgitation of formula in a 6-week-old infant prompted an escalation of the patient's workup to include a barium swallow, which subsequently showed compression of the esophagus caused by a vascular ring. In some cases direct observation with a laryngoscope or bronchoscope might be necessary to determine the cause of stridor. Indications for hospitalization of patients with stridor include stridor at rest, dyspnea, actual or suspected epiglottis, repeatedly awakening from sleep with stridor, a history of rapid progression of symptoms, toxic appearance, and apneic or cyanotic episodes. The primary care provider should be familiar with the evaluation and management for patients with the complaint of persistent or recurrent stridor.
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2/29. 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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3/29. situs inversus totalis and corrected transposition of the great arteries [I,D,D] in association with a previously unreported vascular ring.

    A 3-month-old girl with "noisy breathing" was found to have situs inversus totalis, corrected transposition of the great arteries [I,D,D], and a vascular ring. The ring was composed of a left aortic arch with normal branching pattern and a right ligamentum arteriosum that extended from a diverticulum off the descending aorta and coursed retroesophageal and to the right to join the pulmonary artery. There was no circumflex component of the aorta or aberrant subclavian artery. The descending aorta was left sided. Compression of the esophagus and trachea was noted on contrast esophagram, magnetic resonance imaging (MRI), and at the time of surgery to divide the vascular ring. In association with her corrected transposition, the patient also was shown to have a mild Ebstein's deformity of the right-sided (systemic) atrioventricular valve and electrocardiographic evidence of Wolfe-Parkinson-White syndrome. The combination of situs inversus totalis, corrected transposition of the great arteries [I,D,D], and an aortic arch anomaly has not been previously reported. In addition, the aortic arch anomaly suggested by MRI imaging and confirmed at surgery has previously only been postulated to exist but to our knowledge never reported.
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4/29. Recurrent respiratory tract infections and dysphagia in a child with an aortic vascular ring.

    Recurrent respiratory tract infections and dysphagia after the first years of life are rarely caused by vascular rings, and only a high index of clinical suspicion helps to avoid diagnostic delay and inappropriate treatment. Diagnostic workup in a 2-year-old girl with acute foreign body impaction into the esophagus and frequent respiratory tract infections revealed right descending aortic arch with ligamentum arteriosum as the cause of extrinsic esophageal-tracheal compression. Dividing the ligament gave release to the encircled esophagus and trachea. Relief of symptoms was achieved immediately after surgery.
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5/29. Two fatal complications after parallel tracheal-esophageal stenting.

    Two patients with malignant obstructions of both the trachea and esophagus underwent parallel stent placement with Gianturco-Rosch Z (GRZ) stents for palliation of symptoms. Fatal hemorrhage occurred in both patients 2 and 3 weeks after stent placement respectively. An autopsy performed on one of these patients demonstrated esophageal tissue necrosis and erosion with perforation of both the tracheal and esophageal walls at sites where the stent struts were in direct opposition, leading to bleeding from the esophageal venous plexus. GRZ stents have been successful in the treatment of both solitary tracheal and esophageal stenoses. However, parallel tracheal-esophageal stenting with GRZ stents places patients at high risk for complications due to the high radial force exerted by this particular stent and the minimal amount of intervening tissue between the two structures.
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keywords = esophagus
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6/29. tracheal stenosis caused by false aneurysm of the right subclavian artery.

    The development of tracheal stenosis following insertion of a central venous catheter is a rare complication of this procedure. We present the case of an 81-year-old woman, who suffered acute onset of dyspnea, stridor and dysphagia 4 weeks after coronary artery bypass surgery. Investigations revealed a false aneurysm of the right subclavian artery, compressing the trachea and the oesophagus. The iatrogenic lesion was caused by the insertion of a central venous catheter via the right subclavian route. By the time symptoms developed the catheter had already been removed.
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7/29. Complete airway obstruction in a ventilated patient after oesophageal dilatation.

    A case of instrumental perforation of the oesophagus is presented. This caused systemic sepsis, requiring tracheal intubation and positive pressure ventilation. Sudden unexpected life-threatening airway obstruction was caused by distal tracheal compression by a peritracheal abscess. The aetiology and management of distal tracheal obstruction is discussed.
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8/29. Chronic inspiratory stridor secondary to a retained penetrating radiolucent esophageal foreign body.

    Although foreign body ingestions are common in infants and young children, penetration of the esophagus is a relatively rare event. Timely diagnosis is impeded by the absence of classical symptoms and by the ingestion of radiolucent foreign bodies. The authors present a 17-month-old girl with a 6-month history of inspiratory stridor. An extensive workup found a penetrating radiolucent foreign body at the thoracic inlet.
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keywords = esophagus
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9/29. The Montgomery T-tube in terminal care.

    PURPOSE: The use of a Montgomery T-tube as a palliative measure in the treatment of patients with respiratory obstruction due to cancer is described. patients AND METHOD: Six patients with terminal malignant disease presented with airway obstruction caused by direct infiltration of the trachea by tumor. The primary carcinoma originated in the esophagus in five cases, whereas one patient had metastatic carcinoma of the breast. In each case, the airway was initially secured using a rigid ventilating bronchoscope that was advanced past the area of tracheal obstruction. Tumor was removed from the lumen of the bronchoscope with suction and cup forceps. anesthesia was continued through the bronchoscope while the trachea was exposed through a cervical incision and a window cut in the anterior tracheal wall. A Montgomery T-tube was inserted as the bronchoscope was withdrawn. RESULTS: This technique allowed dramatic relief of airway obstruction in all cases. The tube relieves the obstruction by stenting the airway and permits speech in most patients. The authors stress the need for frank discussion with patients and family when considering the appropriateness for this form of palliation.
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keywords = esophagus
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10/29. Management of acute dilatation of the oesophagus presenting as stridor.

    Acute dilatation of the oesophagus causing stridor is rare. A case is presented and the literature is reviewed with emphasis on the management of this problem.
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