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This article has a correction

Please see: BMJ Case Reports 2012;2012

BMJ Case Reports 2012; doi:10.1136/bcr-2012-006557
  • Unusual presentation of more common disease/injury

Bilateral pneumothoraces and pulmonary oedema following tracheostomy induced by acute tracheal obstruction

  1. Dermot Kelly2
  1. 1Department of Anaesthesia, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2Department of Anaesthesia and Intensive Care, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
  3. 3Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Ireland
  1. Correspondence to Dr Deepak Kumar, drkumar22{at}gmail.com

Summary

We describe the presentation of bilateral pneumothoraces with pulmonary oedema following an elective tracheostomy. A 69-year-old man underwent panendoscopy following primary chemoradiotherapy for locally invasive vocal cord carcinoma. A tracheostomy was performed for upper airway oedema and necrosis. Postoperatively, acute airway obstruction with profound desaturation developed. Tracheostomy tube suctioning dislodged an airway clot with clinical improvement and restoration of bilateral breath sounds. A chest X-ray subsequently demonstrated bilateral pneumothoraces with marked pulmonary oedema. Management, including chest drain insertion, resulted in stabilisation and subsequent full recovery. This case highlights the potential for more than one cause of life-threatening complication following tracheostomy. The importance of considering multiple pathologies in the setting of severe hypoxia and to institute prompt management is emphasised.

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