Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
Department of Forensic Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan.
J Forensic Leg Med. 2021 Jul;81:102177. doi: 10.1016/j.jflm.2021.102177. Epub 2021 May 6.
Percutaneous tracheostomy is commonly performed in the emergency department or intensive care unit to secure the airways of patients. This procedure is associated with a low incidence of complications; however, some of them, such as iatrogenic pneumothorax, can be fatal. Pneumothorax after percutaneous tracheostomy is most often caused by perforation of the tracheal wall or malposition of the cannula. A woman in her 80s was referred to the emergency department owing to persistent and prolonged coughing. Having speculated that she had acute epiglottitis, and having failed to achieve oral tracheal intubation, the physician performed a percutaneous tracheostomy to secure her airway. However, progressive percutaneous emphysema developed immediately thereafter, and the patient died shortly. Postmortem computed tomography showed bilateral pneumothorax. Forensic autopsy revealed that the tracheostomy cannula had failed to reach the trachea and was erroneously inserted into the right thoracic cavity via peritracheal route. Thus, it was determined that the patient's death was attributable to tension pneumothorax caused by cannula malposition during attempted tracheostomy. To the best of our knowledge, this is the first forensic autopsy case report on fatal tension pneumothorax caused by attempted percutaneous tracheostomy.
经皮气管切开术常用于急诊科或重症监护病房，以确保患者的气道通畅。该手术的并发症发生率较低；然而，其中一些并发症，如医源性气胸，可能是致命的。经皮气管切开术后发生气胸通常是由于气管壁穿孔或套管错位引起的。一位 80 多岁的女性因持续且长时间咳嗽被转至急诊科。医生推测她患有急性会厌炎，并未能进行经口气管插管，因此进行了经皮气管切开术以确保她的气道通畅。然而，随后立即出现进行性经皮气肿，患者不久后死亡。死后计算机断层扫描显示双侧气胸。法医尸检显示，气管切开套管未能到达气管，而是通过气管周围路径错误地插入右侧胸腔。因此，确定患者的死亡归因于尝试经皮气管切开术时套管位置不当导致的张力性气胸。据我们所知，这是首例因尝试经皮气管切开术导致致命张力性气胸的法医尸检案例报告。
