Complete bronchial obstruction by granuloma in a paediatric patient with translaryngeal endotracheal tube: a case report

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• 作者：Nao Okuda (8)
  Emiko Nakataki (8)
  Taiga Itagaki (8)
  Mutsuo Onodera (8)
  Hideaki Imanaka (9)
  Masaji Nishimura (8)
  
  8. 3-18-15 Kuramoto ; Tokushima ; 770-8503 ; Japan
  9. 2-50-1 Kuramoto ; Tokushima ; 770-8503 ; Japan
  
• 关键词：Bronchial obstruction ; Granuloma ; Translaryngeal endotracheal tube
• 刊名：Journal of Medical Case Reports
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：8
• 期：1
• 全文大小：1,192 KB
• 参考文献：1. Colice, GL (1992) Resolution of laryngeal injury following translaryngeal intubation. Am Rev Respir Dis 145: pp. 361-364 CrossRef
  2. Rosenfeld, RM, Stool, SE (1992) Should granulomas be excised in children with long-term tracheotomy?. Arch Otolaryngol Head Neck Surg 118: pp. 1323-1327 CrossRef
  3. Carr, MM, Poje, CP, Kingston, L, Kielma, D, Heard, C (2001) Complications in pediatric tracheostomies. Laryngoscope 111: pp. 1925-1928 CrossRef
  4. Taha, MS, Mostafa, BE, Fahmy, M, Ghaffar, MK, Ghany, EA (2009) Spiral CT virtual bronchoscopy with multiplanar reformatting in the evaluation of post-intubation tracheal stenosis: comparison between endoscopic, radiological and surgical findings. Eur Arch Otorhinolaryngol 266: pp. 863-866 CrossRef
  
• 刊物主题：Medicine/Public Health, general; General Practice / Family Medicine; Public Health; Primary Care Medicine;
• 出版者：BioMed Central
• ISSN：1752-1947

文摘

Introduction Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation. Case presentation 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.