scholarly journals Food for Thought: Dietary Intervention in a Rare Cause of Severe Ventilatory Failure

2020 ◽  
Author(s):  
Henry Yung ◽  
Keshav Sharma ◽  
William Flowers ◽  
Malcolm Marquette ◽  
Laura Starace ◽  
...  
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Dietary Intervention ◽  
Rare Condition ◽  
Substantial Improvement ◽  
Airway Compromise ◽  
Plastic Bronchitis ◽  
Enteral Diet ◽  
Tissue Plasminogen ◽  
Ventilatory Failure ◽  
Dietary Strategies

Plastic bronchitis is a rare condition characterised by endobronchial cast formation. We report the case of a 53-year-old women who deteriorated following an elective bronchoscopy procedure. She developed refractory ventilatory failure and required repeated bronchoscopy, which identified thick tenacious casts as the cause of her airway compromise. She did not respond to conventional therapies including endoscopic clearance, mucolytic therapy and nebulised tissue plasminogen activator (TPA). Total parenteral nutrition and a fat-free enteral diet were instituted while the patient was on extracorporeal membrane oxygenation (ECMO), which led to substantial improvement in her condition and demonstrated the importance of dietary strategies in this case.

scholarly journals An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre

2015 ◽  
Vol 7 (2) ◽  
pp. 93-96 ◽  
Author(s):  
CB Pratibha ◽  
Deepthi Satish ◽  
Suraj Gopal
Keyword(s):  
Foreign Body ◽  
Subcutaneous Emphysema ◽  
Rare Condition ◽  
Interesting Case ◽  
Valsalva Manoeuvre ◽  
Laryngeal Edema ◽  
Airway Compromise ◽  
Air Leak ◽  
Spontaneous Pneumomediastinum ◽  
Laryngeal Involvement

ABSTRACT Aim To discuss a case of spontaneous pneumomediastinum with pneumothorax with subcutaneous emphysema presenting with stridor due to laryngeal edema with relevant review of literature. Background Spontaneous pneumomediastinum is a rare condition that has been described in healthy individuals following Valsalva manoeuvre, excessive and prolonged cough or emesis. Laryngeal involvement in these cases has not been reported so far. Case description We present an interesting case of spontaneous pneumomediastinum with pneumothorax with pneumopericardium and cervicofacial emphysema with suspected ingestion of foreign body. In view of stridor due to laryngeal edema tracheostomy was done. No obvious cause for the air leak was found on further investigations. The foreign body sensation could have led to oral provocative manoeuvres by the patient causing increased intra-alveolar pressures and air leak. Conclusion Spontaneous pneumomediastinum with cervicofacial emphysema with pneumopericardium with laryngeal involvement is very rare. Tracheostomy is essential in case of airway compromise. A thorough evaluation for the underlying condition is essential to prevent further air leak. Clinical significance In a case of spontaneous pneumomediastinum with airway compromise due to involvement of the larynx, tracheostomy is essential to secure the airway and could also help in resolution of emphysema. How to cite this article Pratibha CB, Satish D, Gopal S, Balasubramanya AM. An Interesting Case of Spontaneous Pneumomediastinum with Subcutaneous Emphysema following Oral Provocative Manoeuvre. Int J Otorhinolaryngol Clin 2015;7(2):93-96.

DOZ047.79: Bronchoscopic treatment of plastic bronchitis in children

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
M Y Erdas ◽  
N Valiyev ◽  
K K Cerit ◽  
Y Gokdemir ◽  
G Kiyan
Keyword(s):  
Respiratory Distress ◽  
Rare Condition ◽  
Airway Disease ◽  
Underlying Disease ◽  
Bronchial Tree ◽  
X Rays ◽  
Plastic Bronchitis ◽  
Left Hemithorax ◽  
X Ray ◽  
Chest X Ray

Abstract Purpose Plastic bronchitis or cast bronchitis is a rare condition characterized by the formation of large gelatinous or rigid airway casts. Classification of plastic bronchitis is done by disease association and cast histology. This rare condition can cause airway obstruction and there is no standardized treatment. Here are presented two cases with plastic bronchitis treated by bronchoscopic removal of casts in our clinic. Patients Case 1: A 9-year-old boy presented with wheezing, cough, and respiratory distress. He expectorated the cast spontaneously and the cast was misdiagnosed as germinative membrane of a hydatid cyst at the previous center. Total collapse of the left hemithorax was seen on chest X-ray. Any underlying disease was not detected. The plastic-like solid structure was detected and easily extracted from the bronchial tree. Pathology results of the casts were eosinophilic mucoid casts. The patient experienced three bronchoscopic removals and had no recurrence thereafter for two years. Case 2: A 7-year-old girl presented with persistent cough and respiratory distress. The patient was referred to our center with the diagnosis of foreign body aspiration. Total collapse of the right middle and lower segment and partial collapse of the upper segment were seen on chest X-ray. Previously, she was diagnosed with reactive airway disease. The plastic-like semisolid structure was detected during bronchoscopy its extraction from the bronchial tree was not easy but was possible. Pathology results were eosinophilic mucoid and fibrinotic casts. This patient still needs bronchoscopy for cast removal after 12 bronchoscopic removals but her symptoms and bronchoscopy findings have regressed with time. Conclusion Bronchoscopic extraction of casts provides fast improvement of patients’ symptoms and postoperative chest X-rays, but recurrence of cast formation is common. Nevertheless, it is the mostly chosen therapy in the literature. Further researches in this area are required.

scholarly journals Optimizing Management of Otophyma: A Case Series Highlighting the Role of Surgical and Retinoid Therapy

2020 ◽  
pp. 014556132094761
Author(s):  
Michela M. Paradiso ◽  
Benjamin H. Kaffenberger ◽  
Alexander N. Rock ◽  
Edward E. Dodson
Keyword(s):  
Clinical Decision Making ◽  
Case Series ◽  
Chronic Otitis Media ◽  
Rare Condition ◽  
Clinical Decision ◽  
Substantial Improvement ◽  
Functional Improvement ◽  
Successful Approach ◽  
Conductive Hearing

Otophyma is a rare condition that can result in conductive hearing loss. Current otophyma literature does not examine validated treatment outcomes for patients. Utilizing a medical and surgical approach to maintain a patent canal can lead to significant objective improvements. The aim of this case series is to describe a combined successful approach in 3 cases from an academic, multidisciplinary center. The main outcomes analyzed were pre and post air-bone gap audiogram analysis and disimpaction frequency. The results showed that post-management, patient 1 had substantial improvement in hearing, recovering 49 dB in his right ear and 25 dB in his left ear, demonstrating near complete air-bone gap closure. Patient 2 showed a similar dermatologic and functional improvement, although objective audiometric assessment related to otophyma could not be performed due to coexisting chronic otitis media and cholesteatoma. Patient 3, in the 12 months prior to comanagement, had 8 bilateral disimpactions, and following comanagement had 2 disimpactions in 23 months. All 3 patients were pleased with the resultant functional and physical appearance following comanagement. By presenting this approach and objective measures of treatment, we hope to improve future clinical decision-making in a rare condition.

scholarly journals Management of plastic bronchitis with nebulized tissue plasminogen activator: another brick in the wall

2014 ◽  
Vol 40 (1) ◽  
pp. 18 ◽  
Author(s):  
Massimo Colaneri ◽  
Andrea Quarti ◽  
Marco Pozzi ◽  
Stefano Gasparini ◽  
Ines Carloni ◽  
...  
Keyword(s):  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Plastic Bronchitis ◽  
Tissue Plasminogen

Successful use of extracorporeal membrane oxygenation in a child with obstructive shock due to massive bilateral pulmonary embolism

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 323-325 ◽  
Author(s):  
Aditya Badheka ◽  
Pradeep Bangalore Prakash ◽  
Veerajalandhar Allareddy
Keyword(s):  
Pulmonary Embolism ◽  
Extracorporeal Membrane Oxygenation ◽  
Muscular Atrophy ◽  
Venous Malformation ◽  
Rare Condition ◽  
Massive Pulmonary Embolism ◽  
Spinal Muscular Atrophy Type ◽  
Membrane Oxygenation ◽  
Catheter Directed Thrombolysis ◽  
Va Ecmo

Background: Acute massive pulmonary embolism (PE) is a very rare condition in children. We report the successful use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) as a lifesaving modality in a child with acute massive PE. Case presentation: A nine-year-old female with spinal muscular atrophy type 1, chronic respiratory failure with tracheostomy and ventilator dependence presented with tachypnea and hypoxia. She had recent coiling of her pulmonary arterio-venous malformation. A chest computerized tomography scan showed massive bilateral PE. Urgent catheter-directed thrombolysis failed. She was placed on VA-ECMO with stabilization of hemodynamics. She underwent surgical thrombo-embolectomy followed by weaning of ECMO support. Discussion: The use of VA ECMO supported the cardio-respiratory status and perfusion to facilitate surgical embolectomy.

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