Fujisawa Tokuo, Hatakeyama Junji, Omoto Kenichiro
Department of Emergency and Critical Care Medicine, National Hospital Organization Tokyo Medical Center, Japan.
Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Japan.
Respir Med Case Rep. 2023 May 11;44:101866. doi: 10.1016/j.rmcr.2023.101866. eCollection 2023.
We report a rare case of airway obstruction caused by megaesophagus associated with achalasia. A 78-year-old man was admitted with post meal dyspnea, decreased consciousness, expiratory and inspiratory wheezing, and respiratory distress. Arterial blood gas analysis showed findings of marked acute respiratory acidosis (pH 7.18, PaCO 75 mmHg, PaO 225 mm Hg, HCO 22 mmol/L). An emergency laryngoscopy was performed because of a suspected airway obstruction, but no abnormalities were observed from the airway to the glottis. Noninvasive positive pressure ventilation (NPPV) was immediately introduced, and the respiratory rate and breathing pattern was normalized. A chest X-ray showed an enlarged upper mediastinal outline and an ill-defined border of the trachea. A computed tomography (CT) scan showed an enlarged esophagus with a maximum diameter of 9.90 cm, compressing the trachea to the back of the sternal notch. Following removal of the esophageal contents using a nasogastric tube, NPPV was discontinued with no respiratory episodes. After he was stabilized, he was transferred to another hospital for endoscopic myotomy. In a review of the literature, we identified 66 cases of airway obstruction due to achalasia, mainly in older women. None of the patients received NPPV. As a differential diagnosis for acute airway obstruction, achalasia-related airway obstruction should be considered, particularly in older women. Furthermore, since this condition is suspected to involve tracheomalacia, NPPV may be a useful respiratory support therapy.
我们报告一例罕见的由贲门失弛缓症相关的巨食管引起的气道梗阻病例。一名78岁男性因餐后呼吸困难、意识减退、呼气和吸气时哮鸣音以及呼吸窘迫入院。动脉血气分析显示明显的急性呼吸性酸中毒（pH 7.18，动脉血二氧化碳分压75 mmHg，动脉血氧分压225 mmHg，碳酸氢根22 mmol/L）。由于怀疑气道梗阻进行了紧急喉镜检查，但从气道到声门未观察到异常。立即采用无创正压通气（NPPV），呼吸频率和呼吸模式恢复正常。胸部X线显示上纵隔轮廓增宽，气管边界不清。计算机断层扫描（CT）显示食管扩张，最大直径为9.90 cm，将气管压迫至胸骨切迹后方。通过鼻胃管清除食管内容物后，NPPV停止，未再出现呼吸事件。病情稳定后，他被转至另一家医院接受内镜下肌切开术。在文献回顾中，我们确定了66例由贲门失弛缓症引起的气道梗阻病例，主要发生在老年女性。这些患者均未接受NPPV治疗。作为急性气道梗阻的鉴别诊断，应考虑贲门失弛缓症相关的气道梗阻，尤其是老年女性。此外，由于怀疑这种情况涉及气管软化，NPPV可能是一种有用的呼吸支持治疗方法。
