title: When percutaneous dilation tracheotomy may be hazardous: abnormal course of the brachiocephalic trunk.
abstract: BACKGROUND
  Percutaneous dilatational tracheotomy (PDT) is becoming increasingly popular in present day critical care medicine. In contrast to the surgical approach, PDT involves a blind puncture and dilation of the pretracheal space, which may predispose to dangerous complications in the case of anatomical, in particular vascular, anomalies.
  
  
  RESULTS
  We report on two patients, in whom an abnormal pulsation was detected when the infracricoid region was palpated in preparation for PDT. An immediately performed ultrasound scan revealed an arterial blood vessel in front of the upper part of the trachea. A subsequent CT-angiography showed an anomalous course of the brachiocephalic trunk. While too dangerous for PDT, the local department of cranio-maxillofacial surgery was consulted for surgical tracheotomy.
  
  
  CONCLUSIONS
  To avoid hazardous bleeding complications in PDT we recommend at least an ultrasound scan in case of an abnormal pulsation and an enlarged thyroid gland.
authors.affiliation: Department of Neurology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48129, Muenster, Germany. minnerup@uni-muenster.de.
authors.forename: Jens
authors.initials: J
authors.lastname: Minnerup
authors.forename: Oliver
authors.initials: O
authors.lastname: Summ
authors.forename: Christian
authors.initials: C
authors.lastname: Oelschlaeger
authors.forename: Thomas
authors.initials: T
authors.lastname: Niederstadt
authors.forename: Ralf
authors.initials: R
authors.lastname: Dittrich
authors.forename: Johannes
authors.initials: J
authors.lastname: Kleinheinz
authors.forename: Rainer
authors.initials: R
authors.lastname: Dziewas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016122:Brachiocephalic Trunk / Q000002:abnormalities*; D000075202:Contraindications; D003422:Critical Care; D005260:Female; D006801:Humans; D014140:Tracheotomy / Q000379:methods