Abstract
We report here a 59-year-old man with a saber-sheath tracheal narrowing who was scheduled to undergo pharyngeal tumor resection under general anesthesia. The tracheal narrowing was not clearly detected by chest radiography during the preoperative examination, but it was visible on axial computed tomography (CT) images taken earlier for diagnostic purposes. Following fiber optic examination of the narrowed segment with the patient under anesthesia, the tube was inserted into the trachea using an Airway Scope. The tube was deliberately advanced into the trachea and was able to pass through the stenosis without any resistance. On postoperative radiological analysis, three-dimensional reconstruction of the trachea and virtual bronchoscopic images revealed a saber-sheath type tracheomalacia located from below the cricoid cartilage to the carina. The membranous wall had a normal width. This case indicates that chest radiographs may occasionally be inadequate for evaluating asymptomatic patients with tracheomalacia. If CT images have been taken for diagnostic purposes, they should be examined together with the chest radiograph. Digital chest radiography with edge enhancement may become a useful tool in the preoperative detection and evaluation of undetectable tracheal narrowing on conventional chest films.
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References
Miñambres E, Burón J, Ballesteros MA, Llorca J, Muñoz P, González-Castro A. Tracheal rupture after endotracheal intubation: a literature systematic review. Eur J Cardiothorac Surg. 2009;35:1056–62.
Carretta A, Melloni G, Ciriaco P, Libretti L, Casiraghi M, Bandiera A, et al. Preoperative assessment in patients with postintubation tracheal stenosis: rigid and flexible bronchoscopy versus spiral CT scan with multiplanar reconstructions. Surg Endosc. 2006;20:905–8.
Gillespie S, Farling PA. III. Preoperative assessment of the airway: should anaesthetists be making use of modern imaging techniques? Br J Anaesth. 2004;93:758–60.
Farling PA. Thyroid disease. Br J Anaesth. 2000;85:15–28.
Linna O, Hyrynkangas K, Lanning P, Nieminen P. Central airways stenosis in school-aged children: differential diagnosis from asthma. Acta Paediatr. 2002;91:399–402.
Burden RJ, Shann F, Butt W, Ditchfield M. Tracheobronchial malacia and stenosis in children in intensive care: bronchograms help to predict outcome. Thorax. 1999;54:511–7.
Kwong JS, Müller NL, Miller RR. Diseases of the trachea and main-stem bronchi: correlation of CT with pathologic findings. Radiographics. 1992;12:645–57.
Fujita H, Kawahara H, Hidaka M, Yoshimatsu H. The latissimus dorsi muscle flap is useful for the repair of tracheal defects—an experimental study. Jpn J Surg. 1987;17:91–8.
Marty-Ané CH, Picard E, Jonquet O, Mary H. Membranous tracheal rupture after endotracheal intubation. Ann Thorac Surg. 1995;60:1367–71.
Fan CM, Ko PC, Tsai KC, Chiang WC, Chang YC, Chen WJ, et al. Tracheal rupture complicating emergent endotracheal intubation. Am J Emerg Med. 2004;22:289–93.
Harris R, Joseph A. Acute tracheal rupture related to endotracheal intubation: case report. J Emerg Med. 2000;18:35–9.
Konen E, Greenberg I, Rozenman J. Visibility of normal thoracic anatomic landmarks on storage phosphor digital radiography versus conventional radiography. Isr Med Assoc J. 2005;7:495–7.
Acknowledgments
The authors thank Mr. Tatsuo Konishi, radiologist, for his technical help with this paper.
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Hakumoto, Y., Takasugi, Y., Kamamoto, H. et al. Tracheal intubation in a patient with undetectable tracheal narrowing on chest radiography. J Anesth 24, 128–131 (2010). https://doi.org/10.1007/s00540-009-0841-5
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DOI: https://doi.org/10.1007/s00540-009-0841-5