SESSION TITLE: Interventional Pulmonary Cases
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 25, 2015 at 10:45 AM - 11:45 AM
INTRODUCTION: Tracheobronchial injuries are serious and life threatening injuries mainly occurring in setting of high speed crashes, intubations and tracheostomy formation. We present the case of a male patient with known oligodendroglioma whose hospital course was complicated by a tracheal laceration caused by a tracheostomy tube that was repaired with a stent.
CASE PRESENTATION: An 18 year old male patient known to have history of anaplastic oligodendroglioma of the C-spine complicated by quadriplegia was admitted to the hospital because of the inability to handle his own respiratory secretions. His hospital course was complicated by sepsis due to pneumonia and respiratory failure requiring a tracheostomy placement due to prolonged intubation. Three weeks after tracheostomy placement, patient was found to have soft tissue emphysema on the neck and face. CT scan of the chest revealed pneumomediastinum. Patient was transferred to our institution for further management. Bronchoscopy revealed a false passage in the posterior wall of the mid trachea with the tracheostomy tube perforating the tracheal wall. An extra-long tracheostomy tube was not able to bypass the perforation. In lieu of an unstable airway, patient underwent rigid bronchoscopy. The defect was located in the right latero-posterior wall of the mid trachea and had a diameter of 8mm. A silicone Dumon Y stent was customized, after measuring the airways. A customized window was created in the anterior wall of stent for the tracheostomy tube. (Figure) Patient’s pneumomediastinum and subcutaneous emphysema improved immediately and eventually resolved.
DISCUSSION: Surgical and conservative approaches have been described as treatment modalities for tracheal laceration.Criteria defining treatment is based mainly on the size of the laceration along with other exclusions. This case highlights the use of tracheal stenting in the management of tracheal lacerations. It is a technique associated with less morbidity and is the modality of choice in most of the patients with underlying comorbidities deemed high risk for surgery.
CONCLUSIONS: This is an important pathology that should be recognized and prompt treatment initiated. Its prognosis is dictated by the underlying disease process and the overall general condition of the patient.
Reference #1: Gomez-Caro A, Ausin P, Moradiellos FJ, et al. Role of conservative medical management of tracheobronchial injuries. The Journal of trauma. Dec 2006;61(6):1426-1434; discussion 1434-1425.
DISCLOSURE: The following authors have nothing to disclose: Said Chaaban, Michael Simoff, Cyndi Ray, Javier Diaz-Mendoza
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