MyMedR

Usage of airway ultrasound as an assessment and prediction tool of a difficult airway management

Adi O, Fong CP, Sum KM, Ahmad AH

Am J Emerg Med, 2021 04;42:263.e1-263.e4.

PMID: 32994082 DOI: 10.1016/j.ajem.2020.09.011

Airway assessment is important in emergency airway management. A difficult airway can lead to life-threatening complications. A perfect airway assessment tool does not exist and unanticipated difficulty will remain unforeseen. Current bedside clinical predictors of the difficult airway are unreliable but airway ultrasound can be used as an adjunct to predict difficult laryngoscopy. We report a case of a 60-year-old man presenting to the emergency department with shortness of breath, hoarseness of voice and stridor. Airway ultrasound revealed a large laryngeal mass narrowing the upper airway, extending to bilateral vocal cords with heterogenous echogenicity. In view of impending complete upper airway obstruction, acute respiratory distress and airway ultrasound findings, urgent emergency tracheostomy was chosen as definitive airway over endotracheal intubation or surgical cricothyroidotomy. Point of care ultrasound (POCUS) was used to evaluate this patient with severe upper airway obstruction. A laryngeal mass was detected by ultrasound and this pointed towards the presence of a difficult airway. POCUS was a good non-invasive tool used for airway assessment in this uncooperative and unstable patient. Ultrasound predictors of the difficult airway include the inability to visualize the hyoid bone, short hyomental distance ratio, high pretracheal anterior neck thickness and large tongue size. Besides airway assessment, ultrasound can also help to predict endotracheal tube size, confirm intubation and guide emergency airway procedures such as cricothyroidotomy and tracheostomy. Point of care ultrasound of the upper airway can be used in airway assessment to identify distorted airway anatomy, pathological lesions and guide treatment decisions.

Matched MeSH terms: Airway Obstruction/etiology

Fulltext Nasopharyngeal diffuse large B-cells lymphoma causing acute airway obstruction amid COVID-19 crisis: an anaesthetist's nightmare

Yeap TB, Teah MK, Quay YJJ, Wong MTF

BMJ Case Rep, 2021 Jan 28;14(1).

PMID: 33509897 DOI: 10.1136/bcr-2020-241008

Acute stridor is often an airway emergency. We present a valuable experience handling an elderly woman who was initially treated as COVID-19 positive during the pandemic in November 2020. She needed an urgent tracheostomy due to nasopharyngeal (NP) diffuse large B-cell lymphoma causing acute airway obstruction. Fortunately, 1 hour later, her NP swab real-time PCR test result returned as SARS-CoV-2 negative. This interesting article depicts the importance of adequate preparations when handling potentially infectious patients with anticipated difficult airway and the perioperative issues associated with it.

Matched MeSH terms: Airway Obstruction/etiology*

Fulltext Congenital tongue base lipoblastoma causing neonatal airway compromise

Wan MH, Tengku Nun Ahmad TE, Naicker MS, Abu Bakar MZ

BMJ Case Rep, 2021 Jan 18;14(1).

PMID: 33462056 DOI: 10.1136/bcr-2020-239554

Lipoblastomas are benign tumours of immature fat cells presenting in infancy. A lipoblastoma within the airway lumen causing airway compromise is an extremely rare occurrence. We present a 6 hours of life girl who had airway compromise due to a lobulated mass at the base of the tongue. The mass was excised after emergency endotracheal intubation.

Matched MeSH terms: Airway Obstruction/etiology*

Fulltext Massive airway myiasis: an extreme rarity

Teah MK, Chu YM, Shanmuganathan SD, Yeap TB

BMJ Case Rep, 2020 Dec 09;13(12).

PMID: 33298493 DOI: 10.1136/bcr-2020-237764

Intubations are important live saving skills to maintain adequate ventilation and oxygenation. Common indications include impending upper airway obstruction, respiratory failure and impaired conscious level. Oral myiasis is an infrequently found disease which is characterised by ectoparasitic infestation of body tissues by fly maggots.We present a case report and share valuable experiences on a patient with massive airway myiasis causing upper airway obstruction which require emergency intubation.

Matched MeSH terms: Airway Obstruction/etiology

Massive paediatric pulmonary haemorrhage in Dieulafoy's disease: Roles of CT angiography, embolisation and bronchoscopy

Woodhull S, Bush A, Tang AL, Padley S

Paediatr Respir Rev, 2020 Nov;36:100-105.

PMID: 32680823 DOI: 10.1016/j.prrv.2020.06.001

Acute, major pulmonary haemorrhage in children, is rare, may be life-threatening and at times presents atypically. Dieulafoy's disease of the bronchus presenting with recurrent or massive hemoptysis was first described in adults. Prior to reviewing the literature, we report an illustrative case of bronchial Dieulafoy's disease (BDD) in a child presenting unusually with massive apparent hematemesis. The source of bleeding is a bronchial artery that fails to taper as it terminates within the bronchial submucosa. A high index of suspicion is required to identify such lesions via radiological imaging and the role of bronchial artery embolisation is highlighted with video images of angiography included.

Matched MeSH terms: Airway Obstruction/etiology

An unusual cause of subacute airway obstruction in a hemodialysis patient with brachio-cephalic arteriovenous fistula: A rare presentation of central venous occlusion

Hamzan MI, Hamid AR, Halim AS, Mat Saad AZ

Hemodial Int, 2020 04;24(2):E33-E36.

PMID: 32141217 DOI: 10.1111/hdi.12832

A young lady with an arteriovenous (AV) fistula on hemodialysis was referred for surgical management following a failed endovascular approach to relieve central venous occlusion. She had an obstructed left brachiocephalic vein with a history of numerous central vein catheter placements. Alternative routes for new arteriovenous fistula creation had been exhausted due to previous contralateral upper limb fistula rupture and ligation. To the best of our knowledge, no similar cases of airway obstruction in central venous occlusion occurring in hemodialysis patients with AV fistula have been reported. The importance of identifying the possible emergency red flags in hemodialysis patients with central venous occlusion is important to prevent unwanted consequences.

Matched MeSH terms: Airway Obstruction/etiology*

Fulltext Obstructive retrosternal goitre mimicking severe bronchial asthma in pregnancy

Loo GH, Wan Mat WR, Muhammad R, Azman M

BMJ Case Rep, 2019 Aug 04;12(8).

PMID: 31383679 DOI: 10.1136/bcr-2019-229763

Acute airway obstruction in pregnancy remains a challenge to manage. Failure of appropriate and timely airway management may lead to maternal morbidity and mortality such as aspiration pneumonitis or worst hypoxaemic cardiopulmonary arrest. 1 As pregnancy may exacerbate asthma attacks, parturient presenting with wheezing or shortness of breath will commonly be treated as suffering from an asthmatic attack. 2 However, it is important to note other possible differential diagnoses. Thyroid disease is relatively common in women of childbearing age. The thyroid gland undergoes several changes during pregnancy, which may lead to altered function as well as gland enlargement and cause upper airway obstruction and symptoms similar to a bronchial asthma attack. 3 4 With that in mind, we report a case of a parturient with long-standing goitre in her second trimester who presented to our institution with acute respiratory symptoms and cardiopulmonary arrest.

Matched MeSH terms: Airway Obstruction/etiology

Fulltext Point-of-Care Airway Ultrasonography Prior to an Emergency Cricothyroidotomy: Case Report

Iqhbal M, Noor JM, Karim NA, Ismail I, Sanib H, Mokhtar MA, et al.

Sultan Qaboos Univ Med J, 2018 May;18(2):e219-e222.

PMID: 30210855 DOI: 10.18295/squmj.2018.18.02.017

The use of ultrasonography in acute and critical care medicine is becoming increasingly common. However, use of an airway ultrasound as an adjunct to determine the type of intervention needed and assess complications is not common practice. We report a 56-year-old male who presented to the Emergency Department of the Sungai Buloh Hospital, Selangor, Malaysia, in 2015 with hoarseness, stridor and impending respiratory failure. A point-of-care ultrasound performed to assess the neck and vocal cords indicated a heterogeneous echogenic mass in the larynx, thus ruling out a cricothyroidotomy. The patient was therefore referred for an emergency tracheostomy. This case highlights the importance of point-of-care airway ultrasonography in the assessment of patients with stridor. This imaging technique not only helps to detect the cause of the stridor, but also to determine the feasibility of a cricothyroidotomy in emergency cases.

Matched MeSH terms: Airway Obstruction/etiology

Fulltext Metastatic melanoma: a rare cause of central airway obstruction

Abdul Hamid MF, Ban Yu-Lin A, Hassan TM, Mohammad N

BMJ Case Rep, 2017 Nov 04;2017.

PMID: 29103009 DOI: 10.1136/bcr-2017-221545

A middle-aged woman with recurrent malignant melanoma presented initially with massive left pleural effusion. There was a complete obliteration of the left main bronchus on flexible bronchoscopy caused by a mass. Serial cryo-debulking of the tumour was done under rigid bronchoscopy; however, the outcome was not favourable due to the aggressive tumour growth. Vemurafenib was planned after thoracic radiation. She was not keen for the biologics treatment due to financial constraints. We report a case of central airway obstruction due to recurrent aggressive melanoma. More evaluations are needed on the role of interventional pulmonologist for bronchoscopic debulking of this rapidly growing tumour as well as the role of biological agents in treating such cases.

Matched MeSH terms: Airway Obstruction/etiology

Right aortic arch with isolation of the left subclavian artery: a rare association with airway obstruction

Yubbu P, Latiff HA, Adam Abbaker AM

Cardiol Young, 2017 Apr;27(3):613-616.

PMID: 27817752 DOI: 10.1017/S1047951116001840

We present two interesting cases of isolated left subclavian artery from the pulmonary artery with symptoms of upper airway obstruction. The first patient had tetralogy of Fallot, pulmonary artery sling, bilateral superior caval veins, and left bronchial isomerism, suggesting heterotaxy syndrome. The second patient had a right aortic arch, isolated left subclavian artery, and bilateral arterial ducts. These two cases are interesting because of their rarity and uncommon presentation.

Matched MeSH terms: Airway Obstruction/etiology*

Feeding and reflux in children after mandibular distraction osteogenesis for micrognathia: A systematic review

Breik O, Umapathysivam K, Tivey D, Anderson P

Int J Pediatr Otorhinolaryngol, 2016 Jun;85:128-35.

PMID: 27240511 DOI: 10.1016/j.ijporl.2016.03.033

Mandibular distraction osteogenesis (MDO) is becoming increasingly more commonly used as in neonates and infants with upper airway obstruction secondary to micrognathia. A significant number of these children are dependent on nasoenteric feeding or gastrostomies after birth for adequate nutrition and often suffer from gastro-esophageal reflux (GERD).

OBJECTIVE: This analysis is a subset of a larger systematic review. The objective of this study is to determine the effects of MDO on feeding and GERD.

DATA SOURCES: The databases searched included PubMed, Embase, Scopus, Web of Knowledge and grey literature sources.

STUDY SELECTION: The inclusion criterion included studies in children with clinical evidence of micrognathia/Pierre Robin Sequence (PRS) who have failed conservative treatments, including both syndromic (sMicro) and non-syndromic (iPRS) patients. 21 studies relevant to feeding and 4 studies relevant to GERD outcomes were included. All studies included were case series and case reports.

RESULTS: MDO leads to a significant improvement in feeding, with 82% of children feeding exclusively orally after surgery. The overall percentage of children with iPRS who were feeding orally was 93.7% compared with only 72.9% in the sMicro group (p<0.004). A growth decline within the first six weeks after surgery was observed in multiple studies. Overall, out of 70 patients with pre-operative GERD, only four had evidence of GERD after surgery.

CONCLUSIONS: Considering the limitations of this systematic review, this study found that successful relief of airway obstruction by MDO leads to improvement of feeding and improvement in symptoms of GERD in children with upper airway obstruction secondary to micrognathia. Clinicians need to be aware of the risk of growth decline in the initial post-operative period.

Matched MeSH terms: Airway Obstruction/etiology

Mandibular distraction osteogenesis for the management of upper airway obstruction in children with micrognathia: a systematic review

Breik O, Tivey D, Umapathysivam K, Anderson P

Int J Oral Maxillofac Surg, 2016 Jun;45(6):769-82.

PMID: 26867668 DOI: 10.1016/j.ijom.2016.01.009

Mandibular distraction osteogenesis (MDO) is increasingly used for neonates and infants with upper airway obstruction secondary to micrognathia. This systematic review was conducted to determine the effectiveness of MDO in the treatment of airway obstruction. The databases searched included PubMed, Embase, Scopus, and grey literature sources. The inclusion criteria were applied to identify studies in children with clinical evidence of micrognathia/Pierre Robin sequence (PRS) who had failed conservative treatments, including both syndromic and non-syndromic patients. Overall 66 studies were included in this review. Primary MDO for the relief of upper airway obstruction was found to be successful at preventing tracheostomy in 95% of cases. Syndromic patients were found to have a four times greater odds of failure compared to those with isolated PRS. The most common causes of failure were previously undiagnosed lower airway obstruction, central apnoea, undiagnosed neurological abnormalities, and the presence of additional cardiovascular co-morbidities. MDO was less effective (81% success rate) at facilitating decannulation of tracheostomy-dependent children (P<0.0001). Failure in these patients was most commonly due to severe preoperative gastro-oesophageal reflux disease, swallowing dysfunction, and tracheostomy-related complications. The failure rate was higher when MDO was performed at an age of ≥24 months. More studies are needed to evaluate the long-term implications of MDO on facial development and long-term complications.

Matched MeSH terms: Airway Obstruction/etiology

Iatrogenic tracheal flap mimicking tracheal stenosis with resultant stridor

Tan KL, Chong AW, Amin MA, Raman R

J Laryngol Otol, 2012 Jul;126(7):751-5.

PMID: 22578299 DOI: 10.1017/S0022215112000795

To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.

Matched MeSH terms: Airway Obstruction/etiology

Choking on food: a rare case of alexander leukodystrophy and choking

Murty OP, Mun K, Gopinath N, Wong KT

Am J Forensic Med Pathol, 2008 Dec;29(4):364-7.

PMID: 19259028 DOI: 10.1097/PAF.0b013e3181859ff7

Every body has to eat to survive but it becomes a matter of great concern, when the life provider food becomes an asphyxiating agent. In this case, a 60-year-old woman choked herself while swallowing biscuits. On autopsy examination, biscuits were found lodged in larygo-pharynx. Brain showed marked dystrophy and loosened lusterless white matter. On histopathologic examination, brain tissue had numerous eosinophilic globules representing astrocytic processes called "Rosenthal fibers"; hence, it was diagnosed as a case of Alexander dystrophy. It is a disease of white matter, where there is a progressive degeneration of the white matter of the brain because of imperfect growth or development of the myelin sheath. The histopathology of brain showed Rosenthal fibers in abundance. This is one of the rarest disease in which choking can occur because of lack of nervous and muscular coordination and weakness. Its specific relation to choking is documented in this report.

Matched MeSH terms: Airway Obstruction/etiology*

Fulltext Intermittent respiratory obstruction secondary to an antro chonal polyp: a rare late presentation

Shashinder S, Kuljit S, Suhba ST, Arumainathan UD, Gopala KG

Med J Malaysia, 2007 Mar;62(1):72-3.

PMID: 17682578

We describe a child who presented with intermittent respiratory obstruction especially in supine position. Examination revealed a fleshy post nasal mass extending up to the oropharynx. The mass was removed surgically and histopathology revealed an antrochonal polyp. Patient was relieved of his symptoms and has been well ever since.

Matched MeSH terms: Airway Obstruction/etiology*

Fulltext Intermittent respiratory obstruction secondary to a solitary fibrous tumour

Shashinder S, Kuljit S, Rahmat O, Usha DA, Gopala GK

Med J Malaysia, 2006 Oct;61(4):501-2.

PMID: 17243534 MyJurnal

There have been fourteen cases of solitary fibrous tumour reported as originating from the paranasal sinuses. Here we report a case of solitary fibrous tumour that involved the right nasal cavity with extension into the oropharynx causing stertor and intermittent respiratory obtruction. Histopathology examination revealed the tumuor cells expressed CD34 turnout marker.

Matched MeSH terms: Airway Obstruction/etiology*

Fulltext The dilemma of a lateral pharyngeal mass causing stridor in a neonate

Dipak RN, Kailesh P, Sherry MJ, Anindya C

Med J Malaysia, 2005 Oct;60(4):520-2.

PMID: 16570723

Neonatal stridor resulting from intrinsic or extrinsic aberration in the upper respiratory tract often poses not only a diagnostic problem, but also a difficult airway and a dilemma as to the necessity / timing of surgical intervention. A 45 day old female child with increasing stridor since birth was managed by emergency intubation and CT scan followed by excision biopsy of the cystic left sided parapharyngeal mass via a transcervical approach. On histopathology, the excised specimen was reported as cystic salivary choristoma.

Matched MeSH terms: Airway Obstruction/etiology

Malignant cervical teratoma in an adult presenting with impending airway obstruction

Lukman MR, Jasmi AY, Sarinah B, Nurismah MI, Aishah MA

Asian J Surg, 2005 Jul;28(3):227-9.

PMID: 16024322

Extragonadal teratomas and germ cell tumours are uncommon. Most teratomas of the head and neck present in the paediatric age group. Occurrence of such tumours in an adult is extremely rare and, to date, less than 40 cases have been reported in the literature. We report a case of a young man presenting with impending airway obstruction secondary to a malignant teratoma of the neck.

Matched MeSH terms: Airway Obstruction/etiology

Intravenous neck injections in a drug abuser resulting in infection of a laryngocele

Jahendran J, Sani A, Rajan P, Mann GS, Appoo B

Asian J Surg, 2005 Jan;28(1):41-4.

PMID: 15691797

A pyolaryngocele is an uncommon complication of a laryngocele that has become infected. We present a case of a pyolaryngocele that was probably due to repeated injections in the neck veins. The pathogenesis, clinical features and management are discussed in detail.

Matched MeSH terms: Airway Obstruction/etiology

Fulltext Risk factors associated with severe viral croup in hospitalised Malaysian children

Chan PW

Singapore Med J, 2002 Mar;43(3):124-7.

PMID: 12005337

To determine the risk factors associated with severe viral croup in hospitalised Malaysian children.

Matched MeSH terms: Airway Obstruction/etiology*

Displaying publications 1 - 20 of 27 in total