Iatrogenic tracheal flap mimicking tracheal stenosis with resultant stridor

Tan, Keng Lu; Chong, Aun Yeong; Amin, Mohd Afiq; Raman, Rajagopalan

doi:10.1017/s0022215112000795

Cited by 4 publications

(5 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Tracheobronchography performed with low volumes of nonionic water-soluble contrast is safe [67], and useful in the evaluation of TBM because of its high spatial and temporal resolution (figure 2) [68]. Many centres continue to use tracheobronchography [12,67,[69][70][71], often in combination with flexible bronchoscopy [68]. Free breathing, as with many of the imaging techniques, is required for diagnostic accuracy [72].…”

Section: Tracheobronchographymentioning

confidence: 99%

ERS statement on tracheomalacia and bronchomalacia in children

et al. 2019

View full text Add to dashboard Cite

Tracheomalacia and tracheobronchomalacia may be primary abnormalities of the large airways or associated with a wide variety of congenital and acquired conditions. The evidence on diagnosis, classification and management is scant. There is no universally accepted classification of severity. Clinical presentation includes early-onset stridor or fixed wheeze, recurrent infections, brassy cough and even near-death attacks, depending on the site and severity of the lesion. Diagnosis is usually made by flexible bronchoscopy in a free-breathing child but may also be shown by other dynamic imaging techniques such as low-contrast volume bronchography, computed tomography or magnetic resonance imaging. Lung function testing can provide supportive evidence but is not diagnostic. Management may be medical or surgical, depending on the nature and severity of the lesions, but the evidence base for any therapy is limited. While medical options that include bronchodilators, anti-muscarinic agents, mucolytics and antibiotics (as well as treatment of comorbidities and associated conditions) are used, there is currently little evidence for benefit. Chest physiotherapy is commonly prescribed, but the evidence base is poor. When symptoms are severe, surgical options include aortopexy or posterior tracheopexy, tracheal resection of short affected segments, internal stents and external airway splinting. If respiratory support is needed, continuous positive airway pressure is the most commonly used modality either via a face mask or tracheostomy. Parents of children with tracheobronchomalacia report diagnostic delays and anxieties about how to manage their child's condition, and want more information. There is a need for more research to establish an evidence base for malacia. This European Respiratory Society statement provides a review of the current literature to inform future study.

show abstract

Section: Tracheobronchographymentioning

confidence: 99%

ERS statement on tracheomalacia and bronchomalacia in children

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Another postulation for long tracheal flaps is progressive extension of mucosal elevation via the unhealed mucosal tear during each inspiratory effort post extubation as in dissection of blood vessels. 7 The onset of respiratory distress varies, ranging from first hour to 14 days after extubation. The symptoms are cough, hoarseness of voice, stridor and respiratory distress.…”

Section: Discussionmentioning

confidence: 99%

“…In the upright posture, however, the process of respiration (especially when forceful) will cause the flap to act as a one-way valve, allowing expired air to pass up and out easily but trapping inspired air and thus narrowing the tracheal lumen during inspiration. 7 One has to rule out conditions like laryngeal spasm, cord palsy, heart failure, and retention of tracheobronchial secretions, granulation and stenosis.…”

Section: Discussionmentioning

confidence: 99%

Tracheal mucosal flap: A rare cause of delayed onset postextubation stridor

Shameela¹,

Kumari²

2020

IJOAS

View full text Add to dashboard Cite

Tracheal intubation is a commonly done procedure for myriad conditions, mainly in emergency rooms, operation theatres and ICUs. It is associated with several complications especially when performed under emergency conditions. Tracheal mucosal tear is a rare entity which is almost always undiagnosed. At times it leads to mucosal flap which is a cause of delayed onset respiratory distress following extubation. Misdiagnosis of this condition can prove fatal. One such case of tracheal mucosal flap is reported here highlighting the typical clinical features. A detailed study of the pathological process also follows. Awareness of this entity among the medical fraternity handling airway of critically ill patients is of utmost value.

show abstract

“…We probably rarely see tracheal stenosis as a consequence of an overinflated endotracheal tube cuff, because it does not occur so often and in all patients with a supra-distended cuff; or, maybe better, it is not diagnosed so often [17]. Many patients go missing in follow-ups and many stenosis are clinically insignificant and then probably undiagnosed [18].…”

mentioning

confidence: 99%