Pseudomembranous tracheitis is a rare life-threatening complication of endotracheal intubation. The exact mechanism of its formation is not well known, and it could mimic crusting or retained secretions in the trachea. We encountered a patient with history of recent intubation, presenting with acute stridor requiring emergency airway stabilization, and was eventually found to have pseudomembranous tracheitis.
The impaction of dental prostheses in either the airway or esophagus is an under-recognized problem which may result in severe morbidity or even mortality. The radio-opacity and the size of fixed and removable dental prostheses in an animal carcass was investigated. Prostheses were placed one at a time in the oro-laryngopharynx or in tho trachea and the esophagus. Lateral radiographs were taken for each prosthesis in site. The radio-opacity and size of the prostheses on the radiograph was graded. Most of the prostheses investigated were radio-opaque though the removable prostheses were more likely to be radiolucent and differ in size. In a symptomatic patient with a missing dental prosthesis, a negative chest or abdominal radiograph does not exclude impaction, inhalation or ingestion. Further evaluation with endoscopy or even computed tomography may be essential to reduce the possibility of severe morbidity or even mortality.
Laryngotracheal separation is a rare variant of laryngeal trauma. However it is life threatening and potentially fatal. Patients with this injury usually succumb at the site of the accident itself. Here we present two cases of laryngotracheal separation of different etiology and of different outcomes. The treatment advocated for laryngotracheal separation is initially airway stabilization followed by formal repair of the transected trachea. However both our cases illustrates that the outcomes can be different and that a long term treatment plan should be individualized to each patient.
We studied the effect of indomethacin, a cyclooxygenase inhibitor, on bradykinin-induced responses in the intact and denuded epithelium of the isolated tracheal smooth muscle in guinea pigs. Epithelium removal alone did not alter the responsiveness to bradykinin. Indomethacin (2.8 microM) enhanced the sensitivity to bradykinin of both intact and denuded preparations. This finding suggests that the tracheal epithelial may have no protective effect on the contractile responses induced by bradykinin. This may be due to the presence of high amounts of bradykinin-inactivating enzymes in the tracheal smooth muscle. Indomethacin-medicated potentiation caused by bradykinin in epithelium intact and denuded preparations may be an indication of removal of the bronchodilator prostaglandin biosynthesis. The significance of these findings is discussed.
Tracheobronchial injuries are uncommon and a high level of suspicion is needed for immediate diagnosis and prompt treatment. In this case series, two rare cases of tracheobronchial injuries is described showing variable clinical presentations with different levels of injury. Our first case was seen in a 20 years old male whom had a direct impact on the neck and presented with upper tracheal injury. On arrival, this patient was in respiratory distress and had bilateral pneumothorax. Bilateral chest tube was inserted with subsequent neck exploration. During the neck exploration, anastomosis of the injured trachea was performed. The second case was represented by a 35 years old man with right main bronchial injury. Upon initial presentation, this patient appeared well and was comfortable under room air. However he gradually deteriorated one week after the trauma requiring surgical intervention. Eventually a thoracotomy with primary anastomosis of the bronchial tear was performed. Details of both cases including clinical presentation, imaging and procedures done will be discussed in this article.
The effects of a mixed infection of Mycoplasma gallinarum and Newcastle disease virus (F strain) on the tracheal epithelium of village chickens were investigated and observed by scanning electron microscopy. Day-old village chicks were vaccinated intranasally with F strain Newcastle disease virus and inoculated intratracheally on the same day with 10(8) colony forming units of M gallinarum. In another study the chicks were vaccinated and then infected with M gallinarum seven days later. The first group of chicks was euthanased three, seven, 10, 14 and 21 days after vaccination and infection and the vaccinated chicks were euthanased three, seven, 10 and 14 days after infection. In the chicks vaccinated and infected on the same day, major alterations to the tracheal epithelium were visible three days later. There were fewer ciliated cells and the borders of the non-ciliated cells were prominent. Several depressions had formed in the epithelial surface. At higher magnification, clumps of microvilli were visible on some of the non-ciliated cells. Seven days after vaccination and infection, the tracheal epithelium appeared normal, with an increase in the numbers of ciliated cells, although raised borders were observed on the non-ciliated cells in some areas. No clumping of microvilli or depressions in the epithelial surface were observed. In the chicks infected seven days after vaccination, the tracheal epithelium appeared normal with no visible changes on its surface.
Airway stem/progenitor epithelial cells (AECs) are notable for their differentiation capacities in response to lung injury. Our previous finding highlighted the regenerative capacity of AECs following transplantation in repairing tracheal injury and reducing the severity of alveolar damage associated acute lung injury in a rabbit model. The goal of this study is to further investigate the potential of AECs to re-populate the tracheal epithelium and to study their stimulatory effect on inhibiting pro-inflammatory cytokines, epithelial cell migration and proliferation, and epithelial-to-mesenchymal transition (EMT) process following tracheal injury. Two in vitro culture assays were applied in this study; the direct co-culture assay that involved a culture of decellularised tracheal epithelium explants and AECs in a rotating tube, and indirect co-culture assay that utilized microporous membrane-well chamber system to separate the partially decellularised tracheal epithelium explants and AEC culture. The co-culture assays provided evidence of the stimulatory behaviour of AECs to enhance tracheal epithelial cell proliferation and migration during early wound repair. Factors that were secreted by AECs also markedly suppressed the production of IL-1β and IL-6 and initiated the EMT process during tracheal remodelling.
Tracheal tears are not as uncommon as initially thought. The resultant insufficiency and hypoxia can be life-threatening. The keystone in management is early recognition and diagnosis. Immediate surgical repair is essential.
Normal tracheal mucociliary clearance is the key to maintaining the health and defense of respiratory airway. Therefore the present of cilia and mucous blanket are important for tracheal epithelium to function effectively. In the present study, we prepared a tissue engineered respiratory epithelium construct (TEREC) made of autologous respiratory epithelium cells, fibroblast and fibrin from sheep owns blood which replaced a created tracheal mucosal defect. Scanning electron microscopy (SEM) showed encouraging result where immature cilia were present on the surface of TEREC. This result indicates that engineered respiratory epithelium was able to function as normal tissue.
Twenty-four 8 to 9 week-old Pasteurella multocida -free rabbits were divided into three equal groups, the first group was pretreated with hydrocortisone and inoculated intranasally with pasteurella multocida serotype A:3. The second group was inoculated intranasally with P. multocida without hydrocortisone treatment. The third group was inoculated with phosphate buffered saline only and used as a control group. Pasteurella multocida was isolated from the nasal cavity of all infected rabbits in group 1 and 2 and from the trachea of seven rabbits in group 1 and five rabbits in group 2. This study was conducted to observe the ultrastructural changes of the upper respiratory tract of hydrocortisone treated and non-treated rabbits infected with P. multocida serotype A:3. The ultrastructural changes detected in infected rabbits were ciliary destruction and deciliation of the ciliated epithelial cells, cellular swelling, goblet cell hyperplasia and endothelial cell damage. Pasteurella multocida was observed attached to the degenerated cilia, microvilli and mucus. Pasteurella multocida infection was associated with inflammatory responses, which may have caused tissue damage. It is possible that hydrocortisone modulates the severity of infection as an immune suppressor and an inhibitor of goblet cell secretion.
In vitro experiments were undertaken to study the adhesion and colonization to tracheal mucosa, lung and aorta explants from freshly killed rabbits of two different strains of Pasteurella multocida. Serotype A:3 (capsulated, fimbriae +, haemagglutination -, dermonecrotic toxin -) isolated from a rabbit with rhinitis, and serotype D:1 (non-capsulated, fimbriae +, haemagglutination +, dermonecrotic toxin +) isolated from a dead rabbit with septicaemia, were used. When the explants were observed under the scanning electron microscope, the type D strain was highly adherent to trachea and aorta explants compared to the type A strain. Adhesion to lung explants was best achieved by the type A strain after 45 min incubation, but after 2 h incubation no significant difference was observed between the strains. Our data indicate that the presence of fimbriae and the absence of capsule seem to enhance the adherence of P. multocida type D strain to tracheal tissue. The capsular material of P. multocida type A strain and the toxin of the type D strain seem to influence the adherence to lung tissue in rabbit. Adhesion of strain D to aorta may indicate the expression of receptors on the endothelium to that strain and may also explain the ability of certain strains to cause septicaemia.
Accidental endobronchial intubation is a frequent complication in critically ill patients requiring tracheal intubation (TI). If such complication occurs, it is more often the right main bronchus that is intubated due to anatomical reasons. Left main bronchus (LMB) intubation is rare. Here, we report a case with auscultatory, bronchoscopic, and radiographic evidence of accidental LMB intubation in a pregnant woman with dengue shock syndrome. We highlight this case to increase awareness about this possible-but-rare complication of TI.
Tracheal agenesis is a rare congenital airway anomaly which presents as an airway emergency at birth. We report a case of late premature Chinese infant with tracheal agenesis type II (by Floyd's classification) who presented with severe respiratory distress at birth. He had multiple failed attempts at intubations with accidental oesophageal intubation and ventilation. Tracheal agenesis with tracheo-oesophageal fistula was suspected from an emergency optical laryngoesophagoscopy done. The infant was subsequently stabilized on oesophageal ventilation. The diagnosis was confirmed on CT scan and parents were counseled regarding the poor outcome and decided for withdrawal at day 7 of life.
Traumatic chest injury with complete tracheo- bronchial disruption is uncommon and occurs in approximately 1% of motor vehicle accidents (MVA) (1,2). Such injuries carry a high mortality and patients rarely survive transfer to hospital. A high index of suspicion facilitates early diagnosis. Early operative intervention is vital for survival. We describe a rare case of traumatic complete disruption of the right mainstem bronchus (RMB) due to blunt chest trauma. The transected airway was reanastomosed emergently avoiding a lung resection.
Foreign body (FB) aspiration is an emergency of concern at all ages. However, in adults, it can present with atypical symptoms such as shortness of breath, wheezing or rarely cyanosis. Aspiration of oral medications is seen in the elderly population with impairment of protective airway mechanism. Treatment of choice is endoscopic removal of the foreign body. We report such a case of foreign body aspiration (potassium chloride tablet), diagnosed on imaging and subsequently developed bronchostenosis. There are a very few reported cases of oral potassium supplement aspiration and associated complications in the literature.
Lipoblastoma is extremely rare and mainly occurs in children younger than 3 years old. It is predominantly found in the extremities and trunk. Head and neck region occurrences are rare; only 4 such cases involving patients who presented with stridor have been previously reported. We report the fifth case of lipoblastoma of the neck with stridor in a 9-year-old girl, which had gradually worsened over the previous year. Imaging showed a retrotracheal mass extending superiorly to the thyroid level and inferiorly to below the carina of the trachea. Total resection of the tumor was performed, and the histopathologic findings were consistent with lipoblastoma. Postoperatively, the patient was well with no complications.
A retrospective study of 54 neonates with Meconium Aspiration Syndrome (MAS) admitted to the Paediatric ICU Penang General Hospital from January 1989-December 1990 was carried out to determine if suction of the trachea at birth was performed in this group of patients. 63% were inborn and 27% outborn. The mean birth weight was 3.2 kg, 83% were ventilated, mean duration of ventilation was five days and the mortality was 24%. 63% had an Apgar Score of less than 5 at 1 min and 65% had thick meconium-stained liquor. Only 48% were intubated and suctioned at birth. Overall tracheal suction rate was low.
Ludwig angina is a fulminant condition that is potentially lethal. If left unrecognized or untreated, this condition carries a mortality rate of up to 50%. We illustrate a case of 43-year-old male who presented with signs and symptoms of Ludwig angina over a period of two days. The patient had history of tooth extraction prior to the onset of symptoms. Despite typical clinical presentation, Ludwig angina was not considered during the first visit to medical. Ludwig angina is a clinical diagnosis that requires high index of suspicion. Delay in the diagnosis increase the risk of airway obstruction due to its rapidly spreading oedema of the upper airway.
Sixty scavenging chickens from villages in Penang were examined for their state of nutrition or body condition and the presence of helminthic parasites. The majority of the chickens were of poor body condition. More than 66.7% (females) and 73.3% (males) belonged to the ‘below normal’ category of general body condition. A total of eight different helminth species were recovered from the trachea and the gastrointestinal tract of the various chickens. Four of the species were nematodes and the rest were cestodes. No trematodes were recovered from the chickens. The highest mean worm burden was recorded for the cestode Raillietina echinobothrida while the lowest was the nematode, Ascaridia galli.