Sonoda Seijiro, Sato Kozo, Takagi Yoshito, Sato Yumiko, Murao Fumi, Koide Yasuhiro, Oda Toshiyuki
Department of Anesthesiology Shonan Kamakura General Hospital Kamakura Japan.
Department of Anesthesiology Shonan Fujisawa Tokusyukai Hospital Fujisawa Japan.
Acute Med Surg. 2021 May 27;8(1):e665. doi: 10.1002/ams2.665. eCollection 2021 Jan-Dec.
A patient with undiagnosed tracheomalacia undergoing surgery experienced accidental expiratory central airway collapse after tracheal intubation. Here, we aimed to diagnose tracheomalacia from the preoperative data.
A 73-year-old man, scheduled for abdominal surgery, had a clinical history of chronic obstructive pulmonary disease. Preoperative chest computed tomography revealed a lateral narrowing of the tracheal shape. After tracheal intubation, we could not manually ventilate the inflated lung. Emergent bronchoscopy findings, including severe expiratory tracheal collapse, indicated a diagnosis of tracheomalacia. We could fully ventilate the patient by moving the endotracheal tube near the tracheal carina and finally changing it to a double-lumen tube. Airway collapse did not occur under spontaneous breathing.
Accidental expiratory central airway collapse could occur in patients with undiagnosed tracheomalacia during surgery. A diagnosis of tracheomalacia should be presumed from a deformed trachea on preoperative imaging and history of chronic obstructive pulmonary disease.
一名患有未确诊气管软化症的患者在手术过程中气管插管后意外发生呼气期中央气道塌陷。在此，我们旨在从术前数据中诊断气管软化症。
一名73岁男性，计划进行腹部手术，有慢性阻塞性肺疾病病史。术前胸部计算机断层扫描显示气管形态侧向变窄。气管插管后，我们无法手动通气膨胀的肺。紧急支气管镜检查结果，包括严重的呼气期气管塌陷，提示气管软化症诊断。通过将气管内导管移至气管隆突附近并最终更换为双腔管，我们能够使患者充分通气。自主呼吸时未发生气道塌陷。
未确诊气管软化症的患者在手术期间可能发生意外的呼气期中央气道塌陷。应根据术前影像学上气管变形和慢性阻塞性肺疾病病史推测气管软化症的诊断。
