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.
Anaesthetic Registrar, Department of Paediatric Anaesthesia, Women's and Children's Hospital, 72 King William Road, North Adelaide, South Australia, 5006.
M J
MJ
Farr
A M
AM
Cyna
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