A case of bilateral pneumothoraces resulting from tracheostomy for advanced laryngeal cancer.
Pneumothorax is a possible complication of tracheostomy. We report a rare case of bilateral pneumothoraces resulting from tracheostomy in an advanced laryngeal cancer patient. A 59-year-old man was referred to our clinic for evaluation and treatment of laryngeal tumor. Laryngeal endoscopy showed limited movement of bilateral vocal cords, and computed tomography revealed a tumor lesion extending from the vocal cords to the subglottic area. Three days after the first visit, the patient developed respiratory difficulty, and we elected to perform emergency tracheostomy for airway management. Immediately after the start of the procedure, he began hyperventilating, and complained of respiratory discomfort and chest pain. We then recognized a mediastinal air leak, and we suspected pneumothorax resulting from the tracheostomy. Chest X-ray showed bilateral pneumothoraces; therefore, we inserted bilateral chest drainage tubes, which stabilized his respiratory condition. We speculated that the pathogenesis of the bilateral pneumothoraces was weakened alveolar walls secondary to long-term smoking, and a significant rise in airway pressure because of airway constriction by the neck-extended position and hyperventilation, during tracheostomy.
Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan; Department of Otolaryngology, Japan Self Defense Forces Hospital Fukuoka, 1-61 Kokurahigashi, Kasuga, Fukuoka 816-0826, Japan.
Akihiro
A
Himeno
Department of Otolaryngology - Head and Neck Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-0042, Japan. Electronic address: morningconference@r8.dion.ne.jp.
Atsushi
A
Tamura
D058109:Airway Management / Q000379:methods*; D015505:Chest Tubes; D006801:Humans; D007822:Laryngeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000000981:diagnostic imaging* / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D013902:Radiography, Thoracic; D013907:Thoracostomy / Q000379:methods; D014057:Tomography, X-Ray Computed; D014139:Tracheostomy
Bilateral pneumothoraces; Laryngeal cancer; Tracheostomy