Life-threatening acute airway obstruction induced by unsuspected achalasia

Upper airway obstruction is a potentially life-threatening emergency often encountered in the acute care, perioperative, and critical care settings. One important complication of acute obstruction is negative-pressure pulmonary edema (NPPE). We describe two cases of acute upper airway obstruction, both of which resulted in flash pulmonary edema complicated by acute hypoxic respiratory failure. Though NPPE was suspected, these patients were also found to have Takotsubo syndrome (TTS). Neither patient had prior cardiac disease, and both subsequently had a negative ischemic workup. Because TTS is a condition triggered by hyperadrenergic states, the acute airway obstruction alone or in combination with NPPE was the likely explanation for TTS in each case. These cases highlight the importance of also considering cardiogenic causes of pulmonary edema in the setting of upper airway obstruction, which we suspect generates a profound catecholamine surge and places patients at increased risk of TTS development.

Download Full-text

Life-Threatening Acute Airway Obstruction

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2005.07.010 ◽

2005 ◽

Vol 19 (5) ◽

pp. 659-660 ◽

Cited By ~ 1

Author(s):

Murali Chakravarthy ◽

Patil Thimmannagowda ◽

Vivek Jawali

Keyword(s):

Airway Obstruction ◽

Acute Airway Obstruction ◽

Life Threatening

Download Full-text

Laryngeal manifestations of pachyonychia congenita: a clinical case and discussion on management for the otolaryngologist

The Journal of Laryngology & Otology ◽

10.1017/s0022215116008264 ◽

2016 ◽

Vol 131 (S2) ◽

pp. S53-S56 ◽

Cited By ~ 2

Author(s):

A M O'Kane ◽

C P Jackson ◽

M Mahadevan ◽

C Barber

Keyword(s):

Airway Obstruction ◽

Potassium Titanyl Phosphate ◽

Early Evaluation ◽

Acute Airway Obstruction ◽

Laryngeal Disease ◽

Pubmed Search ◽

Life Threatening ◽

Potassium Titanyl Phosphate Laser ◽

Pachyonychia Congenita ◽

Laryngeal Involvement

AbstractBackground:Pachyonychia congenita is a rare keratinising disorder, which typically presents during the first three years of life and usually affects the nails and palmoplantar surfaces. It can involve the larynx and potentially result in life-threatening airway obstruction.Methods:A case report is presented and the findings of a literature review are reported. The review involved a PubMed search using the keywords ‘pachyonychia congenita’ together with ‘larynx’, ‘laryngeal involvement’, ‘laryngeal obstruction’, ‘airway obstruction’, ‘hoarseness’ and/or ‘stridor’.Results:A five-year-old boy, with confirmed pachyonychia congenita, presented with complications of laryngeal involvement over a four-year period. He required three intubations and a tracheostomy for acute airway obstruction. Treatment with potassium titanyl phosphate laser laryngoscopy stabilised the progression of laryngeal disease.Conclusion:Patients with pachyonychia congenita and laryngeal involvement can have a varied presentation, ranging from hoarseness to acute airway obstruction. Management can be a challenge, requiring early evaluation, regular surveillance and aggressive treatment. This paper reports our experience in managing and treating the laryngeal complications of a child with pachyonychia congenita.

Download Full-text

Life-threatening delayed arterial hemorrhage following anterior cervical spine surgery: A case report and literature review

Surgical Neurology International ◽

10.25259/sni_225_2020 ◽

2020 ◽

Vol 11 ◽

pp. 124

Author(s):

Giovanni Miccoli ◽

Emanuele La Corte ◽

Ernesto Pasquini ◽

Giorgio Palandri

Keyword(s):

Cervical Spine ◽

Airway Obstruction ◽

Operating Room ◽

Spine Surgery ◽

Superior Thyroid Artery ◽

Cervical Spine Surgery ◽

Anterior Cervical Spine Surgery ◽

Acute Airway Obstruction ◽

Life Threatening ◽

The Right

Background: One of the most serious and potentially life-threatening adverse events associated with anterior cervical spine surgery is postoperative hematoma with acute airway obstruction. The causes of unpredicted delayed bleeding are, however, not fully elucidated. Here, we report a case of delayed arterial bleeding and sudden airway obstruction following a two-level ACDF. Case Description: A 52-year-old male presented with the right paracentral disc herniations at the C4–C5 and C5–C6 levels. A two-level ACDF was performed. Notably, on the 5th postoperative day, the patient developed an acute respiratory distress due to a large right lateral retrotracheal hematoma requiring emergency evacuation at the bedside. This was followed by formal ligation of a branch of the right superior thyroid artery in the operating room. In addition, an emergency tracheotomy was performed. By postoperative day 15, the tracheotomy was removed, and the patient was neurologically intact. Conclusion: A superior thyroid artery hemorrhage should be suspected if a patient develops delayed neck swelling with or without respiratory decompensation several days to weeks following an ACDF. Notably, these hematomas should be immediately recognized and treated (i.e., decompression starting at the bedside and completed in the operating room) to prevent catastrophic morbidity or mortality.

Download Full-text

Ludwig’s Angina: An Update of Clinical Features and Management

Ibrahim Cardiac Medical Journal ◽

10.3329/icmj.v7i1-2.53959 ◽

2019 ◽

Vol 7 (1-2) ◽

pp. 51-56

Author(s):

Syed Hasan Imam Al Masum ◽

Ali Jacob Arsalan

Keyword(s):

Airway Obstruction ◽

Clinical Features ◽

Early Recognition ◽

Case Fatality ◽

Submandibular Region ◽

Acute Airway Obstruction ◽

Life Threatening ◽

History Of ◽

Ludwig’S Angina ◽

Ludwig's Angina

Background & objective: Ludwig’s angina (LA) is a potentially life-threatening, rapidly spreading, bilateral cellulitis of the submandibular spaces in children. In the preantibiotic era, the airway obstruction was almost inevitable and case fatality rate was as high as 60%. With the introduction of antibiotics in 1940s the LA has become an uncommon disease. As such, many physicians have limited experience of it. But its early recognition and aggressive management still carries utmost importance to avoid life-threatening acute airway obstruction. Therefore, the present study was undertaken to update the physicians with clinical features and management of Ludwig’s angina. Methods: The present descriptive study was conducted in Bangladesh Institute of Child Health & Dhaka Shisu Hospital, Sher-e-Bangla Nagar, Dhaka between January 2012 to December 2016. Having obtained approval from the Institutional Review Board of the Institute, we retrospectively analyzed the clinical course and management of Ludwig’s angina. During the period a total of 27 patients’ record were found available. Data were collected on demographic and clinical characteristics, causes and predisposing factors, investigations, complications developed and outcome of LA. Penicillin with or without additional anaerobic coverage with clindamycin or metronidazole were used as key patient management strategy. Steroid was given for faster recovery of the patients having airway compromise. Patients who did not recover with conservative treatment underwent surgical treatment with incision and drainage. Result: In the present study children with Ludwig’s angina presented with bilateral swelling of the neck and submandibular region accompanied by pain and induration in the affected region. Systemic symptoms, such as, fever and malaise were also frequently present. Two-thirds (66%) of the children had dehydration and almost half (48%) had toxic look. Over one-third (37%) of the children exhibited, restricted backward and upward elevation of tongue and over half with trismus. Of the systemic signs, high temperature, tachycardia, and tachypnoea were common presentation. One-third of the children exhibited signs of airway obstruction. Fifty percent of the children had the history of toothache (lower molar) one or two weeks prior to the development of Ludwig’s angina, 40% had history of mumps and 3.7% had history of trauma to the mandible. Over one-quarter developed pneumonia with mediastinitis. Airway obstruction, manifested as unable to swallow saliva, dyspnoea, stridor and cyanosis, was exhibited by over 55% of the children and received intravenous steroid for faster recovery from the condition. More than three-quarters (77.7%) of the patients responded to Penicillin with or without clindamycin or metronidazole and those who did not respond to it (22.3%) underwent operative treatment. Conclusion: Despite modern medical and surgical interventions have improved the outcomes of Ludwig’s angina to a great extent, it still remains a potentially lethal disease in the pediatric population. Early recognition of the disease with identification of airway obstruction and prompt intravenous antibiotic therapy could resolve the disease without any complications or need for surgical intervention. Ibrahim Card Med J 2017; 7 (1&2): 51-56

Download Full-text

DOZ047.96: Esophageal food impaction presenting as life-threatening airway obstruction in children with esophageal atresia

Diseases of the Esophagus ◽

10.1093/dote/doz047.96 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

S Rozycki ◽

T-N Liou ◽

M T Brigger

Keyword(s):

Foreign Body ◽

Airway Obstruction ◽

Esophageal Atresia ◽

Rigid Bronchoscopy ◽

Food Impaction ◽

Esophageal Foreign Body ◽

Acute Airway Obstruction ◽

Respiratory Event ◽

Esophageal Food Impaction ◽

Life Threatening

Abstract Objective An esophageal foreign body rarely presents as an apparent life-threatening event. However, in children with esophageal atresia, strictures and dysmotility can lead to severe food impactions. Given the underlying anatomy of children with esophageal atresia, a unique risk of severe impaction with resultant airway obstruction is possible. This study reports a case of a child in respiratory distress presenting after a choking event where endoscopy revealed near total tracheal compression from esophageal food impaction. Method Case discussion and review of literature are undertaken. Result A 3-year-old boy with trisomy 21 and history of esophageal atresia who had previously undergone successful repair was transported by helicopter after a choking episode. He was witnessed to have cough followed by apnea, cyanosis, and unresponsiveness, for which he underwent the Heimlich maneuver and required chest compressions for a respiratory arrest. He was immediately taken to the operating room for endoscopy with planned foreign body removal. Rigid bronchoscopy noted near complete obstruction of the airway from posterior tracheal wall compression with no airway foreign body. The airway was secured and a combination of rigid and flexible esophagoscopy subsequently extracted a large bolus of chicken. He was observed in the intensive care unit with no further respiratory event after extubation. Conclusion Esophageal dysmotility and strictures are common in children with esophageal atresia who have undergone repair. Mild airway symptoms are common in children with an esophageal foreign body; however, in children with esophageal atresia a high index of suspicion of an esophageal foreign body is requisite in the setting of acute airway obstruction.

Download Full-text

Mind the gap: life-threatening retropharyngeal haematoma resulting in acute airway obstruction following blunt trauma by closing train carriage doors

BJR|case reports ◽

10.1259/bjrcr.20200190 ◽

2021 ◽

pp. 20200190

Author(s):

Shaneil V Patel ◽

Abbas Reza ◽

Scott R Rice

Keyword(s):

Airway Obstruction ◽

Blunt Trauma ◽

Internal Jugular Vein ◽

Jugular Vein ◽

Left Internal Jugular Vein ◽

Significant Delay ◽

Blunt Force Trauma ◽

Venous Injury ◽

Acute Airway Obstruction ◽

Life Threatening

Delayed life-threatening airway obstruction due to venous injury following blunt, non-penetrative trauma to the neck. A rare case of rapid force, blunt trauma by closing train carriage doors, leading to injury to the left internal jugular vein, subsequent retropharyngeal haematoma and airway obstruction. There was a significant delay of a few hours between injury and acute deterioration. Initial dual Phase CT (unenhanced and arterial) studies identified the large retropharyngeal haematoma but the assessment of the source was inconclusive likely due to the venous injury becoming compressed by the swelling/haematoma at the time of investigation. Subsequent triple phase (unenhanced, arterial and venous) studies were performed identifying a flap in the left internal jugular vein as the likely site of vascular injury. A venous origin of haemorrhage supported the patients delayed onset of symptoms following the injury. We suggest with blunt force trauma to the neck, in the context of suspicion of haematoma and airway compromise, the radiologist should consider protocolling a triple phase (unenhanced, arterial and venous) angiographic study.

Download Full-text

A dangerous cause of airway obstruction: deep neck infection

10.22514/sv.2020.16.0101 ◽

2020 ◽

Keyword(s):

Airway Obstruction ◽

Upper Airway ◽

Deep Neck Infection ◽

Jugular Vein Thrombosis ◽

Neck Infection ◽

Vein Thrombosis ◽

Lethal Complications ◽

Life Threatening ◽

Fascial Spaces ◽

Emergency Doctors

Deep neck infection (DNI) is an infection in the fascial spaces of the neck. Complications of DNI, including mediastinitis, internal jugular vein thrombosis, and upper airway obstruction, are severe and potentially life threatening. Therefore, early identification and accurate management of DNI are essential. We review the anatomy of the deep spaces of the neck to determine the route of DNI spread so that emergency doctors, physicians, and otorhinolaryngologists can quickly recognize the development of lethal complications of DNI, such as asphyxia from airway obstruction.

Download Full-text

Burkitt lymphoma of the nasopharynx causing life-threatening airway obstruction: A case report

American Journal of Otolaryngology ◽

10.1016/j.amjoto.2021.102977 ◽

2021 ◽

Vol 42 (4) ◽

pp. 102977

Author(s):

Alexander N. Goel ◽

Andrey Filimonov ◽

Julie Teruya-Feldstein ◽

Christian Salib ◽

Joseph J. Rousso ◽

...

Keyword(s):

Case Report ◽

Airway Obstruction ◽

Burkitt Lymphoma ◽

Life Threatening

Download Full-text

Prolapsed Nasal Polyp Causing Acute Airway Obstruction: An Exceptional Presentation

ORL ◽

10.1159/000513564 ◽

2021 ◽

pp. 1-3

Author(s):

Krupa R. Patel ◽

Ashton E. Lehmann ◽

Aria Jafari ◽

Daniel L. Faden

Keyword(s):

Airway Obstruction ◽

Nasal Polyp ◽

Nasal Polyposis ◽

Upper Airway ◽

Rare Presentation ◽

First Case ◽

Acute Airway Obstruction ◽

History Of ◽

Sinonasal Symptoms ◽

Or History

Although nasal polyposis is a common clinical entity, there is limited literature describing the rare presentation of sudden prolapse of a massive nasal polyp resulting in an airway emergency in an adult. We present the first case report to our knowledge of a patient without any preceding sinonasal symptoms or history of anticoagulation who experienced acute upper airway obstruction due to sudden hemorrhage and prolapse of a large nasal polyp. Based on our experience treating this patient, we discuss special considerations in all phases of care to ensure safe and effective management of such an exceptional clinical scenario.

Download Full-text