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Vol. 54. Issue 9.
Pages 480 (September 2018)
Vol. 54. Issue 9.
Pages 480 (September 2018)
Clinical image
DOI: 10.1016/j.arbr.2018.01.034
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Orotracheal Intubation in a Patient with Known Tracheal Diverticulum
Intubación orotraqueal en paciente con divertículo traqueal conocido
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Fátima Ruiz Camuñasa,
Corresponding author
fatimaruizcamunas@gmail.com

Corresponding author.
, Manuel Valero Cabeza de Vacab, Alberto García Fernándeza
a Unidad de Gestión Clínica de Anestesia y Reanimación, Hospital Universitario de Puerto Real, Cádiz, Puerto Real, Spain
b Hospital Universitario Puerta del Mar, Cádiz, Spain
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We report the case of a female patient who underwent total knee arthroplasty. She had a history of scleroderma-related pulmonary fibrosis with a moderate restrictive pattern, schwannoma at L5, and syringomyelia at L4-L5. She had been operated previously for a fracture of the tibia and fibula, with sequelae of paretic clubfoot. A chest computed tomography (CT) conducted in 2015 revealed a posterior tracheal diverticulum measuring 16mm in the upper third of the trachea, with a 4mm communicating orifice (Fig. 1).

Fig. 1.

Reconstruction of the chest CT scan showing the diverticulum (indicated by the arrow).

(0.08MB).

The entrance of the tracheal diverticulum could be visualized by bronchoscopy with distal placement of the endotracheal tube cuff. This technique was selected to ensure that the distal tip of the endotracheal tube remained in this position, and to avoid the possible complication associated with mechanical ventilation of overstretching and rupturing the diverticulum.1 No clinical changes or variations in ventilatory dynamics were observed during the intervention, and airway pressures remained normal. The patient was extubated without incidents after surgery.2

Bronchoscopy may be useful for the orotracheal intubation of patients with known tracheal diverticula, to ensure the correct positioning of the tube in order to avoid complications derived from mechanical ventilation.

References
[1]
B. Mazul-Sunko, D. Zdencar, I. Kozul, J. Spicek-Macan, D. Stancic-Rokotov.
Pneumomediastinum related to distal tracheal diverticulum.
Anaesthesia, 68 (2013), pp. 422-437
[2]
A.T. Sayit, M. Elmali, D. Saglam, C. Celenk.
The diseases of airway-tracheal diverticulum: a review of the literature.
J Thorac Dis, 8 (2016), pp. E1163-E1167

Please cite this article as: Camuñas FR, de Vaca MVC, Fernández AG. Intubación orotraqueal en paciente con divertículo traqueal conocido. Arch Bronconeumol. 2018;54:480.

Copyright © 2018. SEPAR
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Archivos de Bronconeumología (English Edition)

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