Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Nakwan, Narongwit

doi:10.4187/respcare.02857

Cited by 8 publications

(6 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2,8 For those cases that develop secondary to intubation, it has been postulated that hyper-pressure at the site of endotracheal cuff leads to necrosis of the tracheal mucosa and submucosa with subsequent exposure of the cartilage, chondritis and perichondritis. 1,[10][11][12][13] Histopathology of the tracheal cast in this case report was consistent with a tracheal pseudomembrane due to the presence of neutrophils and fibrin. As the hair fragment and keratin were visualised within the lesion, the tracheal pseudomembrane is postulated to have developed secondary to aspiration pneumonia.…”

Section: Discussionsupporting

confidence: 61%

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

Kwong¹,

Fry²,

Birnie³

2020

Journal of Feline Medicine and Surgery Open Reports

View full text Add to dashboard Cite

Case summary A 6-year-old female spayed Ragdoll presented with a 4-day history of acute onset non-productive retching, coughing and anorexia. A complete blood count, serum biochemistry, thoracic radiography and abdominal ultrasound were performed. Initially, aspiration pneumonia was suspected owing to an alveolar lung pattern in the right cranial ventral lung lobes seen on radiographs. The cat did not improve with empirical antibiotic therapy. Bronchoscopy and bronchoalveolar lavage were performed. An intraluminal tracheal mass was identified and removed via endoscopic guidance and gentle traction. Histopathology results were consistent with a fibrinous tracheal pseudomembrane. The cat was concurrently diagnosed with Pseudomonas aeruginosa pneumonia, which was confirmed on bronchoalveolar lavage. Pseudomonas aeruginosa was also cultured within the pseudomembrane. The cat was received antimicrobial therapy for his Pseudomonas pneumonia. In humans, fibrinous tracheal pseudomembranes occur uncommonly as a complication following endotracheal intubation and rarely due to infectious organisms. As there was no prior history of endotracheal intubation, the development of fibrinous tracheal pseudomembrane in this cat was suspected to be secondary to Pseudonomas aeruginosa aspiration pneumonia. Relevance and novel information The present case report is the first to describe a tracheal pseudomembrane in a cat. Bronchoscopy-guided gentle traction and subsequent removal of the tracheal pseudomembrane resulted in a complete resolution of the clinical signs.

show abstract

Section: Discussionsupporting

confidence: 61%

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

Kwong¹,

Fry²,

Birnie³

2020

Journal of Feline Medicine and Surgery Open Reports

View full text Add to dashboard Cite

show abstract

“…When the capillary perfusion pressure increases to over 18–25 mmHg, mechanical edema and ischemia of the tracheal mucosa [4] could cause mucosal necrosis and erosions, which subsequently lead to the formation of a fibrous granuloma or scar in the tracheal mucosa. Indeed, a membranous flap-like morphology in tracheal obstructions has been described frequently in patients with a history of prolonged intubation or tracheostomy [5], [6], [7], [8], [9], [10], [11], [12]. In the absence of a history of tracheal intubation, we suspect that self-induced vomiting was the cause of our patient's tracheal irritation and membranous tracheal stenosis.…”

Section: Discussionmentioning

confidence: 65%

“…It is speculated that prolonged tracheal intubation exerts excessive or repeated mechanical pressure on the tracheal wall and irritates the tracheal mucosa [5], [6], [7], and that this irritation can result in membranous tracheal stenosis. When the capillary perfusion pressure increases to over 18–25 mmHg, mechanical edema and ischemia of the tracheal mucosa [4] could cause mucosal necrosis and erosions, which subsequently lead to the formation of a fibrous granuloma or scar in the tracheal mucosa.…”

Section: Discussionmentioning

confidence: 99%

Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway

Nakamura

Hisamura

Hashimoto

et al. 2017

Respiratory Medicine Case Reports

View full text Add to dashboard Cite

We report a rare case of acquired membranous tracheal stenosis in a patient with anorexia nervosa and a history of self-induced vomiting, but without a history of tracheal intubation or tracheostomy. A 50-year-old woman presented with difficulty in breathing and swallowing, self-expectoration, and impaired consciousness due to acute benzodiazepine intoxication. Bronchoscopic examination was performed after tracheotomy and placement of a tracheostomy tube failed to secure her respiratory tract and ventilation continued to deteriorate. A flap-like membranous structure was identified on the posterior tracheal wall, obstructing the tracheostomy tube. Physical compression of the membranous structure improved ventilation. Bronchoscopic examination is generally recommended prior to performing tracheostomy in patients suspected to have post-intubation tracheal obstruction. Based on our findings, we suggest that these examinations should also be performed in patients with conditions associated with chronic irritation of the respiratory tract, including those with a prolonged history of self-induced vomiting.

show abstract

“…Since then, only about 30 cases have been reported worldwide. [2][3][4][5][6][7][8][9] The condition presents clinically as stridor or respiratory insufficiency after extubation. It is certainly difficult to differentiate OFTP from other conditions because laryngeal spasm, edema, and the retention of secretions also present with stridor or respiratory insufficiency.…”

Section: Discussionmentioning

confidence: 99%

Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis

Lee

Park

et al. 2014

Korean J Crit Care Med

View full text Add to dashboard Cite

Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

show abstract

Obstructive Fibrinous Tracheal Pseudomembrane: A Rare Condition in Postextubation Stridor

Cited by 8 publications

References 10 publications

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

Tracheal pseudomembrane secondary to aspiration pneumonia in a 6-year-old Ragdoll

Membranous tracheal stenosis in a patient with anorexia nervosa and self-induced vomiting- challenges in securing the airway

Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis

Contact Info

Product

Resources

About