Letter to the Editor
Inflammatory Tracheal Pseudomembrane
Seudomembrana traqueal inflamatoria
Maria del Sol Arenas-de Larriva
, Javier Cosano-Povedano, Andrés Cosano-Povedano
Corresponding author
Unidad de Broncoscopias, Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain
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Compression Secondary to Posterior Sternoclavicular Dislocation" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "306" "paginaFinal" => "307" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Compresión traqueal secundaria a una luxación esternoclavicular posterior" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 542 "Ancho" => 1301 "Tamanyo" => 95229 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial and sagittal computed tomography slice showing posterior displacement of the clavicular head with tracheal compression.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Pedro M. Rodríguez Suárez, Mohamed Hussein Serhal, Jorge L. Freixinet Gilart" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Pedro M." "apellidos" => "Rodríguez Suárez" ] 1 => array:2 [ "nombre" => "Mohamed" "apellidos" => "Hussein Serhal" ] 2 => array:2 [ "nombre" => "Jorge L." "apellidos" => "Freixinet Gilart" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0300289613003104" "doi" => "10.1016/j.arbres.2013.10.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289613003104?idApp=UINPBA00003Z" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001463?idApp=UINPBA00003Z" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001463/v1_201406290026/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Inflammatory Tracheal Pseudomembrane" "tieneTextoCompleto" => true "saludo" => "To the Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "307" "paginaFinal" => "308" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Maria del Sol Arenas-de Larriva, Javier Cosano-Povedano, Andrés Cosano-Povedano" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Maria del Sol" "apellidos" => "Arenas-de Larriva" "email" => array:1 [ 0 => "arlam23@hotmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Javier" "apellidos" => "Cosano-Povedano" ] 2 => array:2 [ "nombre" => "Andrés" "apellidos" => "Cosano-Povedano" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Broncoscopias, Servicio de Neumología, Hospital Universitario Reina Sofía, Córdoba, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Seudomembrana traqueal inflamatoria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 497 "Ancho" => 1801 "Tamanyo" => 137985 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Circumferential fibrinous pseudomembrane. (B) Tracheal lesion. (C) Patient extubation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the recent article from Crespo-Lessmann and Torrego-Fernández in which they present a patient with obstructive inflammatory tracheal pseudomembrane (in the form of a tracheal septum) secondary to repeated endotracheal intubations. In their article, the authors describe the complete resolution of the process with respiratory physiotherapy and the administration of anti-inflammatories (glucocorticoids).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Obstructive fibrinous pseudomembrane is a rare condition, but probably more common than reported in the literature. It originates from ischemia of the tracheal mucosa, usually due to iatrogenesis, inducing the production of growth factors and abnormal regeneration.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> This results in the formation of a fibrous membrane that partially obliterates, and in some cases, even totally obstructs the tracheal lumen.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> As the authors indicate, these acquired inflammatory lesions can resolve spontaneously after a certain length of time. However, the central airway is frequently compromised and urgent endotracheal intervention is required.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We report here our experience with a 69-year-old male non-smoker who had undergone surgery for herniated disc in the lumbar spine, requiring general anesthesia and orotracheal intubation. The procedure was carried out with the patient in the prone position, thus increasing endotracheal tube cuff pressure. During the immediate post-surgical period, the patient suffered respiratory arrest and was reintubated. A flexible bronchoscopy was performed, revealing a partially detached circumferential fibrinous pseudomembrane causing stenosis of the entire upper third of the tracheal lumen (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). A fragment of approximately 2<span class="elsevierStyleHsp" style=""></span>cm that was acting as a valve and may have caused the patient's respiratory arrest was removed with the biopsy forceps during the same procedure. To gain better control of the airway after extraction of the pseudomembrane a rigid bronchoscopy was performed, during which the tracheal lesion was extracted en bloc using the bevel of the tracheoscope (EFER-DUMON<span class="elsevierStyleSup">®</span> caliber 14<span class="elsevierStyleHsp" style=""></span>mm) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). The patient subsequently progressed favorably and could be extubated a few hours later (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). In the case presented by Crespo-Lessmann and Torrego-Fernández,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> the tracheal septum may have originally been a fragment of circumferential pseudomembrane. In their case, the evolving nature of the condition and the clinical picture could have permitted conservative treatment.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Obstructive tracheal pseudomembrane, therefore, must be diagnosed with endoscopy as soon as possible after clinical suspicion has been aroused. Endoscopic monitoring would be advisable in patients who have required prolonged or repeated endotracheal intubations. Since severe respiratory complications are common, therapeutic endoscopy is required in the majority of the cases reported in the literature.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> A conservative approach is only an option in carefully selected patients, and even these patients must be very closely monitored (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Arenas-de Larriva MS, Cosano-Povedano J, Cosano-Povedano A. Seudomembrana traqueal inflamatoria. Arch Bronconeumol. 2014;50:307–308.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 497 "Ancho" => 1801 "Tamanyo" => 137985 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Circumferential fibrinous pseudomembrane. (B) Tracheal lesion. (C) Patient extubation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tabique traqueal inflamatorio" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Crespo-Lessmann" 1 => "A. Torrego-Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.arbres.2012.11.004" "Revista" => array:6 [ "tituloSerie" => "Arch Bronconeumol" "fecha" => "2013" "volumen" => "49" "paginaInicial" => "402" "paginaFinal" => "404" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23419993" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive fibrinous tracheal pseudomembrane" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B.B. Yildirim" 1 => "A. Karalezli" 2 => "H.C. Hasanoglu" 3 => "O. 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Jorens" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00408-010-9263-2" "Revista" => array:6 [ "tituloSerie" => "Lung" "fecha" => "2011" "volumen" => "189" "paginaInicial" => "81" "paginaFinal" => "86" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21082188" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obstructive fibrinous tracheal pseudomembrane" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "B.L. Rice" 1 => "D.A. Culver" 2 => "J.F. Santacruz" 3 => "C.A. Lazar" 4 => "K. McCarthy" 5 => "T.R. Gildea" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2011" "volumen" => "92" "paginaInicial" => "115" "paginaFinal" => "117" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15792129/0000005000000007/v1_201406290026/S1579212914001475/v1_201406290026/en/main.assets" "Apartado" => array:4 [ "identificador" => "14576" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Letters to the editor" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/15792129/0000005000000007/v1_201406290026/S1579212914001475/v1_201406290026/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212914001475?idApp=UINPBA00003Z" ]
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| 2016 September | 38 | 12 | 50 |
| 2016 August | 37 | 7 | 44 |
| 2016 July | 20 | 10 | 30 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 3 | 0 | 3 |
| 2015 October | 34 | 3 | 37 |
| 2015 September | 43 | 8 | 51 |
| 2015 August | 27 | 8 | 35 |
| 2015 July | 26 | 10 | 36 |
| 2015 June | 34 | 6 | 40 |
| 2015 May | 37 | 7 | 44 |
| 2015 April | 29 | 10 | 39 |
| 2015 March | 35 | 6 | 41 |
| 2015 February | 19 | 6 | 25 |
| 2015 January | 32 | 9 | 41 |
| 2014 December | 12 | 7 | 19 |
| 2014 November | 18 | 5 | 23 |
| 2014 October | 42 | 17 | 59 |
| 2014 August | 0 | 2 | 2 |
| 2014 July | 1 | 0 | 1 |
Show all
