title: Complete bronchial obstruction by granuloma in a paediatric patient with translaryngeal endotracheal tube: a case report.
abstract: BACKGROUND
  Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation.
  
  
  METHODS
  A 1-month-old Japanese boy, weighing 3.5kg, was admitted to our hospital owing to cardiac failure caused by an atrial septal defect and intractable arrhythmia. To treat his unstable cardiovascular status, surgery was performed to close his atrial septal defect. After the operation, stenosis was detected by auscultation and flow limitation worsened. A bronchoscopy revealed granulomas completely obstructing his right bronchus and partially obstructing his left bronchus. Dexamethasone infusion partially reduced the mass, after which removal by yttrium aluminium garnet laser was tried. The airway obstruction was not resolved, however, because of granuloma reproliferation. Budesonide (aerosol liquid) inhalation was started, and tissue was reduced using an yttrium aluminium garnet laser and physically removed using forceps. After continued budesonide inhalation, he was successfully liberated from the ventilator.
  
  
  CONCLUSIONS
  Life-threatening airway obstruction by granulomas developed in a translaryngeally intubated paediatric patient. The granuloma was detected after a couple of weeks of intubation. A bronchial granuloma is rare in paediatric patients. It should be suspected with evidence of bronchial obstruction. Treatment with corticosteroids and surgery using a laser maybe indicated.
authors: Nao
authors: N
authors: Okuda
authors: Emiko
authors: E
authors: Nakataki
authors: Taiga
authors: T
authors: Itagaki
authors: Mutsuo
authors: M
authors: Onodera
authors: Hideaki
authors: H
authors: Imanaka
authors: 3-18-15 Kuramoto, Tokushima 770-8503, Japan. nmasaji@tokushima-u.ac.jp.
authors: Masaji
authors: M
authors: Nishimura
mesh_terms: D000280:Administration, Inhalation; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D001982:Bronchial Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D001999:Bronchoscopy; D019819:Budesonide / Q000008:administration & dosage; D003131:Combined Modality Therapy; D006099:Granuloma / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal / Q000009:adverse effects*; D053844:Lasers, Solid-State; D008297:Male
chemical_list: D000893:Anti-Inflammatory Agents; D019819:Budesonide