Subacute airway obstruction from a tracheal mucosal flap.
We report the case of a 15-year-old girl with a near fatal obstructive tracheal lesion following tracheal intubation. The patient developed stridor and acute respiratory distress 29 h following tracheal extubation, after 35 h intubation in the intensive care unit. The failure of conventional management of stridor, including re-intubation, to provide a satisfactory airway prompted an urgent bronchoscopy, which revealed a tracheal mucosal flap causing 80% obstruction of the subglottic trachea. The fibreoptic bronchoscope allowed careful placement of a tracheal tube distal to the obstruction. The patient eventually made a full recovery. The low incidence of similar lesions and the lack of distinguishing clinical features from other causes of post-extubation stridor make diagnosis and appropriate management of this life-threatening condition difficult. We discuss how early consideration of the diagnosis and optimal initial management reduce the risk of an adverse outcome.
Farr
M J
MJ
Anaesthetic Registrar, Department of Paediatric Anaesthesia, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006.
Cyna
A M
AM
D000293:Adolescent; D000402:Airway Obstruction / Q000209:etiology*; D001999:Bronchoscopy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D012135:Respiratory Sounds / Q000209:etiology; D014135:Tracheal Stenosis / Q000150:complications* / Q000175:diagnosis