The Contentious Management of Anaplastic Thyroid Carcinoma with Acute Airway Obstruction during COVID-19 Pandemic

There are many important concerns and issues raised in managing acute airway obstruction cases with regards to the current COVID-19 pandemic. As a further matter, a patient with a huge thyroid mass in anaplastic thyroid carcinoma (ATC) presenting with impending airway obstruction poses treatment challenges, as immediate active intervention is necessary despite the risk of spreading of COVID-19 viruses. The unknown status of COVID-19 of the patient will add additional concerns during active assessment and treatment as patients with this undifferentiated thyroid carcinoma commonly deteriorate fast. This carcinoma may also invade the trachea and result in upper airway obstruction leading to a fatal outcome. Therefore, an appropriate treatment strategy is essential. This report highlights a case of an ATC patient who presented with diffuse cemented-hard anterior neck, whereby the whole management of ATC with acute airway obstruction during this COVID-19 pandemic is purely contentious and challenging. The issue of providing artificial ventilation either via intubation or tracheostomy is made more complicated as the patient presents with an acute upper airway obstruction whilst the COVID-19 status is unknown. While endotracheal intubation approach was not easy, the trachea was also difficult to be identified externally due to the huge ‘cemented-hard’ mass plastered over the compressed trachea. Due to the advanced disease, surgical intervention was not an option.

AN INTRIGUING CASE OF LARYNGEAL FIBROLIPOMA - CASE REPORT AND REVIEW OF LITERATURE

Although fibrolipomas are common benign mesenchymal tumors and are frequently found in trunk and limbs, their occurrence in head and neck is rare and still rarer is their endolaryngeal presence. They may cause clinical dilemma due to their rarity and varied clinical presentations from progressive dysphagia to acute airway obstruction. We present a case of laryngeal fibrolipoma in an adult Indian male who presented with progressive obstructive sleep apnea and sudden appearance of a mass in oral cavity which was removed via transoral endoscopic approach. Keywords– Fibrolipoma larynx, lipoma, obstructive sleep apnea, transoral excision

Acute Airway Obstruction from Megaoesophagus Secondary to Achalasia Evaluated with Flexible Bronchoscope

A 94-year-old female presented to the emergency department with acute expiratory stridor. In the absence of an otorhinolaryngologist, an urgent laryngoscopy was performed using a flexible bronchoscope by an anaesthesiologist in the emergency department leading to a change in management. Subsequent radiographs confirmed severe tracheal compression from megaoesophagus secondary to achalasia as the cause of acute airway obstruction. Use of flexible bronchoscope as a diagnostic tool by an anaesthesiologist to evaluate a patient presenting with signs of acute airway obstruction may lead to a safer and more careful airway management planning. Suggestions are also made regarding establishment of emergency surgical airways when conventional approaches fail.

Recurrent transient loss of airway secondary to regurgitated pedunculated hypopharyngeal liposarcoma

We describe a rare case of hypopharyngeal liposarcoma with an atypical presentation. The patient presented with a 3-month history of intermittent, transient acute airway obstruction. In between episodes, he was asymptomatic. A pedunculated tumour originating in the postcricoid region was seen to be suspended into the oesophagus and intermittently regurgitated into the larynx to cause airway obstruction. The lesion was endoscopically removed and examined histologically to confirm the diagnosis. On-going management of rare lesions such as this should be through multidisciplinary team meetings at a tertiary sarcoma centre.

Prolapsed Nasal Polyp Causing Acute Airway Obstruction: An Exceptional Presentation

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.

Laryngopyocele: 10 Years’ Experience in a Tertiary Institution, South-South, Nigeria

Laryngopyocele is an infected laryngocele: Rarer than laryngocele. An estimated 8% of laryngoceles get infected and become laryngopyocele with features of acute airway obstruction and sepsis with resultant fatality. Laryngocele is more common in Caucasian males population after the 5th decades of life. Mostly acquired though could be congenital. Most are unilateral with no predominance for the left or the right. Recently, laryngocele is categorized into internal or mixed (combined). Laryngopyocele accounted for 0.15% of 1376 ENT surgical procedures done in our operative theatre in a period of 10 years. Both were males in their 3rd decade. The first case reported with clinical features of upper airway obstruction from left laryngopyocele. Plain radiographs and computed scan of the neck revealed features of right laryngocele with contralateral left laryngopyocele. The second patient had recurrent right laryngopyocele. Twice general practitioners previously operated upon him before presenting in our facility. The two cases were successfully managed through external approach under general anesthesia with a small size endotracheal intubation. The mean follow-up period was 4 years without recurrence. There is dearth of literature on this subject in our environment; therefore, this article is an addition to literature.