Fatal airway obstruction due to a ball-valve clot with identical signs of tension pneumothorax

Abstract

Fatal airway obstruction due to a ball-valve clot with identical signs of tension pneumothoraxEndo-tracheal tube obstruction due to an extensive blood clot is a recognized but very rare complication. A ball-valve obstruction in the airway could function as a check valve for the lung and thorax, resulting in tension pneumothorax-like abnormalities. A 47-year-old female patient had undergone implantation of a left ventricular assist device 3 weeks prior. On postoperative day 17, planned thoracentesis was performed for drainage of a pleural effusion. Despite the drainage, the patient's oxygenation did not improve, and emergency tracheal intubation was conducted. Subsequent computed tomography revealed bilateral pneumothorax. Two days later, the patient's trachea was extubated without complication, and a minitracheostomy tube was placed. Three hours later, reintubation was conducted due to progressive tachypnea. Although successful intubation was confirmed, ventilation became increasingly difficult and finally impossible. Marked increase in pulmonary artery and central venous pressures suggested progression of the previous tension pneumothorax. After emergency extracorporeal membrane oxygenation was initiated, fiberoptic bronchoscopy revealed the presence of a massive clot and ball-valve obstruction of the endotracheal tube. Two weeks later, the patient died due to severe hypoxic brain damage. Diagnosis of ball valve clot is not simple, but intensivists should consider this rare complication.

Iatrogenic tension pneumocephalus complication of osteoradionecrosis in the treatment of nasopharyngeal carcinoma. A case report and critical literature review

“…[6] NPC typically originates in the fossa of Rosenmüller, located superior and posterior to the torus tubarius, where the mucosal epithelium directly overlies the underlying lymphoid tissue. [7,8] Clinical manifestations of NPC encompass a spectrum of symptoms, such as epistaxis, nasal obstruction, unilateral hearing loss, otalgia, otorrhea, headache, cranial nerve involvement, and vascular injury. [9,10] NPCs are endemic in Southeast Asia and among Eskimo populations in Alaska and Greenland, with an annual incidence of 30 cases per 100,000 people, attributed to childhood consumption of salted fish and exposure to nitrosamines [11] and polycyclic hydrocarbons in salt-preserved foods.…”