Oyake Momoko, Suenobu Souichi, Miyawaki Michiyo, Ohchi Yoshifumi, Ihara Kenji
Department of Pediatrics, Oita University Faculty of Medicine, Yufu, JPN.
Division of General Pediatrics and Emergency Medicine, Department of Pediatrics, Oita University Faculty of Medicine, Yufu, JPN.
Cureus. 2022 Feb 1;14(2):e21799. doi: 10.7759/cureus.21799. eCollection 2022 Feb.
Anterior mediastinal tumors can occasionally cause acute respiratory failure by compressing the trachea and bronchi. In such cases, sedative muscle relaxants during tracheal intubation can cause fatal complete tracheal obstruction. We encountered a 15-year-old male patient with T-lymphoblastic lymphoma (T-LBL) of the anterior mediastinum. For his airway emergency due to the stenosis extended from the lower part of the trachea to the tracheal bifurcation, venovenous (VV) extracorporeal membrane oxygenation (ECMO) was introduced from the femoral vein under local anesthesia. After a short period of tracheal intubation management, an endotracheal stent (ES) was immediately placed in the lower trachea. We performed a needle biopsy, and he was diagnosed with T-LBL. Following the diagnosis, chemotherapy was introduced. The ES was able to secure sufficient tracheal diameter, and ECMO and ventilation were promptly discontinued. In the case of tracheal stenosis from the lower part of the trachea due to anterior mediastinal tumor, depending on the degree of stenosis, VV ECMO can be considered. Moreover, ES can lead to early weaning from VV ECMO and a ventilator.
前纵隔肿瘤偶尔可因压迫气管和支气管而导致急性呼吸衰竭。在这种情况下，气管插管期间使用镇静性肌肉松弛剂可导致致命的完全气管阻塞。我们遇到一名15岁男性前纵隔T淋巴细胞母细胞淋巴瘤（T-LBL）患者。由于气管下段至气管分叉处狭窄导致气道紧急情况，在局部麻醉下经股静脉建立了静脉-静脉（VV）体外膜肺氧合（ECMO）。经过短期气管插管管理后，立即在气管下段置入气管支架（ES）。我们进行了针吸活检，他被诊断为T-LBL。诊断后开始化疗。ES能够确保足够的气管直径，ECMO和通气迅速停止。对于因前纵隔肿瘤导致气管下段狭窄的情况，可根据狭窄程度考虑VV ECMO。此外，ES可导致早期撤掉VV ECMO和呼吸机。
