[Unexpected treatable dyspnea caused by intratracheal granuloma in an amyotrophic lateral sclerosis patient with mechanical ventilation].
Respiratory insufficiency is a problem that develops in nearly all people diagnosed with amyotrophic lateral sclerosis (ALS). A 46-year-old man with ALS, who had been in a bedridden state with tracheal ventilation support, complained of faintness and dyspnea. The airway pressure of the ventilator had increased, and bleeding from the trachea had occurred several times. A fiberoptic bronchoscopy showed granulation located on the anterior wall of the trachea and severe airway obstruction of the tracheostomy tube. Although a long tracheostomy tube had been intubated for the initial management of the tracheal granulation, a tumor on the posterior tracheal wall had relapsed and occluded the tracheal lumen. A self-expandable metallic airway stent was placed into the tracheal stenosis. After stenting, his symptoms of dyspnea and syncope imploved, and the increased airway pressure of the ventilator was normalized. We speculated that the tracheal granuloma had occurred due to a tracheal mucosal injury related to endotracheal suctioning. We should pay attention to complaints of dyspnea in ALS patients with tracheostomy and make a careful consideration to airway care including suction management.
Ishida
Shimon
S
Division of Neurology, the First Department of Internal Medicine, Osaka Medical College.
Kimura
Fumiharu
F
Hosokawa
Takafumi
T
Satoh
Toshihiko
T
Furutama
Daisuke
D
Sugino
Masakazu
M
D000690:Amyotrophic Lateral Sclerosis / Q000150:complications*; D004417:Dyspnea / Q000209:etiology* / Q000628:therapy*; D015769:Granuloma, Respiratory Tract / Q000209:etiology*; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects*; D015607:Stents; D014133:Tracheal Diseases / Q000209:etiology*; D014139:Tracheostomy / Q000009:adverse effects; D016896:Treatment Outcome