title: Bilateral pneumothoraces and pulmonary oedema following tracheostomy induced by acute tracheal obstruction.
abstract: We describe the presentation of bilateral pneumothoraces with pulmonary oedema following an elective tracheostomy. A 69-year-old man underwent panendoscopy following primary chemoradiotherapy for locally invasive vocal cord carcinoma. A tracheostomy was performed for upper airway oedema and necrosis. Postoperatively, acute airway obstruction with profound desaturation developed. Tracheostomy tube suctioning dislodged an airway clot with clinical improvement and restoration of bilateral breath sounds. A chest X-ray subsequently demonstrated bilateral pneumothoraces with marked pulmonary oedema. Management, including chest drain insertion, resulted in stabilisation and subsequent full recovery. This case highlights the potential for more than one cause of life-threatening complication following tracheostomy. The importance of considering multiple pathologies in the setting of severe hypoxia and to institute prompt management is emphasised.
authors.affiliation: Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland. drkumar22@gmail.com
authors.forename: Deepak
authors.initials: D
authors.lastname: Kumar
authors.forename: Brendan
authors.initials: B
authors.lastname: O'Hare
authors.forename: Conard
authors.initials: C
authors.lastname: Timon
authors.forename: M
authors.initials: M
authors.lastname: Mukhtar
authors.forename: Dermot
authors.initials: D
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000402:Airway Obstruction / Q000209:etiology* / Q000628:therapy; D015505:Chest Tubes / Q000009:adverse effects; D003251:Constriction, Pathologic / Q000209:etiology; D004322:Drainage; D042241:Early Diagnosis; D006801:Humans; D000860:Hypoxia; D008297:Male; D011030:Pneumothorax / Q000209:etiology* / Q000628:therapy; D011654:Pulmonary Edema / Q000209:etiology* / Q000628:therapy; D014132:Trachea / Q000473:pathology*; D014134:Tracheal Neoplasms / Q000150:complications / Q000601:surgery*; D014139:Tracheostomy / Q000009:adverse effects*; D016896:Treatment Outcome