Department of Anesthesiology, Kinki University School of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
J Anesth. 2010 Feb;24(1):128-31. doi: 10.1007/s00540-009-0841-5.
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.
我们在此报告一例 59 岁男性患者，其存在剑鞘样气管狭窄，拟在全身麻醉下进行咽部肿瘤切除术。术前检查中胸部 X 线摄影术未能明确检测到气管狭窄，但在用于诊断的轴向计算机断层扫描（CT）图像中可见。在纤维光镜检查麻醉下狭窄段后，使用气道镜将管插入气管。管被故意推进气管并能够毫无阻力地通过狭窄部位。术后放射学分析显示，气管的三维重建和虚拟支气管镜图像显示位于环状软骨以下至隆突的剑鞘样气管软化。膜壁具有正常的宽度。该病例表明，胸部 X 线摄影术偶尔可能不足以评估无症状的气管软化患者。如果已拍摄 CT 图像用于诊断，则应与胸部 X 线片一起检查。边缘增强的数字胸部 X 线摄影术可能成为术前检测和评估常规胸片上不可检测的气管狭窄的有用工具。
