An unusual cause of trachael stenosis

Abstract

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.Objectif : Rapporter le cas d'un important corps étranger trachéal causant une sténose de la trachée chez une fillette de 11 ans.Éléments cliniques : L'histoire évoquait une maladie obstructive chronique et des bronchectasies associées. L'examen physique a révélé des crépitations et des ronchus diffus au thorax. Les gaz du sang étaient normaux. Les radiographies pulmonaires ont montré des bronchectasies et la scintigraphie de ventilation et de perfusion a identifié une fistule trachéo-oesophagienne. Pendant l'anesthésie, réalisée pour confirmer la présence d'une fistule, l'intubation et la ventilation ont été difficiles à cause de la sténose trachéale. L'hypoventilation a provoqué une hypercapnie et une acidose sévères. La tomographie subséquente a montré une sténose de 2 mm de diamètre sur 1 cm de long au tiers moyen de la trachée, une bronchectasie et une poche d'air entre la trachée et l'oesophage. Les épreuves fonctionnelles respiratoires (EFR) ont montré une obstruction importante. Le traitement antituberculeux, fondé sur l'hypothèse retenue de sténose tuberculeuse et de fistule trachéo-oesophagienne, a causé un délai pendant lequel l'état de la patiente s'est détérioré, la dyspnée intermittente devenant une orthopnée accompagnée d'hypercapnie et d'acidose sévères. L'anesthésie pratiquée pour la reconstruction de la trachée a été difficile ...

A Chronic Glottic Foreign Body Diagnosed by Radiograph after 9 Months of Symptoms

“…Indications for tracheostomy were chronic subglottic foreign bodies, sharp subglottic foreign bodies, or foreign bodies that were larger than the subglottic opening [ 9 ]. In addition to granulation tissue, other complications of a chronic airway foreign body may include stenosis, pulmonary infiltrates, infection, or tracheoesophageal fistula [ 6 , 10 ]. Postoperative management and follow-up care for patients with chronic foreign bodies should be provided with these complications in mind.…”

Complete upper airway obstruction after induction of anesthesia in a child with undiagnosed lingual tonsil hypertrophy

“…Sudden unexpected airway obstruction at the induction of anesthesia in infants and children has been reported widely. Among the causes are supraglottic cysts (1), laryngomalacia (2), arytenoid prolapse (3), tracheobronchomalacia (4), aneurysms (5) or other cardiovascular causes (6), chronic tracheal foreign bodies (7), and mediastinal masses (8–10).…”