title: Spontaneous expectoration of an obstructive fibrinous tracheal pseudomembrane after tracheal intubation.
abstract: We report a rare and potentially life-threatening complication related to tracheal intubation in the formation of obstructive tracheal pseudomembrane. In the present case, the pseudomembrane was spontaneously expectorated; this is very unusual and not been reported before. This condition was first misdiagnosed as edema subglottis. Then, computed tomography revealed a stenosis of the middle trachea, but subsequent flexible bronchoscopy was unable to provide additional information regarding its nature. Before attending a rigid bronchoscopy, planned to better define the cause of stenosis, a thick annular membrane was scraped away with a large amount of coughing. After that, the patient's respiratory symptoms completely resolved. Control at 1 and again 3 months later showed no further tracheal stenosis. The diagnosis of obstructive tracheal pseudomembrane should be considered in cases of post-extubation stridor. Flexible bronchoscopic guidance after extubation may allow to diagnose such a complication earlier, but rigid bronchoscopy remains the treatment of choice.
authors.affiliation: Thoracic Surgery Unit, Second University of Naples, Piazza Miraglia 2, I-80138 Naples, Italy.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Fiorelli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vicidomini
authors.forename: Gaetana
authors.initials: G
authors.lastname: Messina
authors.forename: Mario
authors.initials: M
authors.lastname: Santini
mesh_terms: D000328:Adult; D000402:Airway Obstruction / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D008297:Male; D012075:Remission, Spontaneous; D014135:Tracheal Stenosis / Q000209:etiology* / Q000473:pathology