Traqueomalacia, complicación de la exéresis de un bocio difuso endotorácico bilateral / Tracheomalacia: a complication after removal of bilateral endothoracic diffuse goiter

Introducción: En cirugía de la glándula tiroides la mortalidad es nula en algunas series por lo que la morbilidad es la mayor preocupación del cirujano. Objetivo: Presentar la evolución clínica de una paciente con tiroidectomía total por bocio endotorácico bilateral. Caso clínico: Paciente que se le realizó tiroidectomía total por bocio endotorácico bilateral, técnicamente difícil, biopsia por congelación negativa de malignidad, bocio coloide. Nervios recurrentes visualizados. Debido al tamaño de la glándula y lo complejo que resultó la extracción se decidió trasladar a la paciente a la sala de recuperación intubada y ventilada para proceder a la recuperación de la ventilación espontánea y la extubación en un período más prolongado. Fue extubada una primera vez que fue fallida. Fue reintubada y ocurrió en una segunda ocasión después de ser reintervenida por un posible hematoma de la herida. En la TAC preoperatoria se observó una glándula tiroides grande con prolongación endotorácia bilateral y estenosis alta de la tráquea. Conclusión: Las complicaciones de obstrucción de la vía aérea después de una tiroidectomía no son frecuentes. Generalmente, después de una tiroidectomía total o parcial se trata de recuperar al paciente en el quirófano para después de la extubación realizar una laringoscopia que descarte la parálisis de las cuerdas vocales. La traqueomalacia como complicación después de una tiroidectomía no es frecuente, por lo que se alerta que de no haber diagnosticado y tratado rápidamente la paciente podría tener un desenlace fatal(AU)

Introduction: In surgery of the thyroid gland, mortality is null in some series, so morbidity is the surgeon's greatest concern. Objective: To present the clinical evolution of a patient with total thyroidectomy due to bilateral endothoracic goiter. Clinical case: This patient underwent total thyroidectomy due to bilateral endothoracic goiter, technically difficult, negative freeze biopsy of malignancy, colloid goiter. Visualized recurrent nerves. Due to the size of the gland and how complex the extraction was, it was decided to transfer the patient to the intubated and ventilated recovery room to proceed with the recovery of spontaneous ventilation and extubation in a longer period. She was extubated the first time it failed. She was re-intubated and it occurred on a second occasion after being re-operated due to a possible hematoma of the wound. In the preoperative CT scan, a large thyroid gland with bilateral endothoracic prolongation and high stenosis of the trachea was observed. Conclusion: Complications of airway obstruction after thyroidectomy are not frequent. Generally, after a total or partial thyroidectomy, it is a matter of recovering the patient in the operating room, in order to perform, after extubation, a laryngoscopy to rule out paralysis of the vocal cords. Tracheomalacia as a complication after thyroidectomy is not frequent, so it is warned that failure to diagnose and treat the patient quickly could have a fatal outcome(AU)

Lower airway anomalies in infants with laryngomalacia.

Objective. To study the prevalence of associated airway anomalies in infants presenting with moderate to severe laryngomalacia. Methods. Eighty three symptomatic infants with recurrent respiratory symptoms including wheeze and cough diagnosed as moderate to severe laryngomalacia based on their clinical and direct laryngoscopic findings were subjected to fiberoptic bronchoscopy (FOB) during the period March 2007 to February 2009 in the Department of Pulmonology, Institute of Child Health and Hospital for Children, Chennai, India. Analysis of the clinical features, radiological findings and associated lower airway anomalies by FOB was done. Results. Lower airway anomalies were demonstrated in 40 (48%) infants of the study population. Tracheomalacia was the most common lower airway anomaly 24(29%) followed by bronchomalacia 8(10%) and tracheobronchomalacia 6 (7%). (4:1:1). Conclusion. Infants with moderate and severe laryngomalacia should be evaluated with flexible fibreoptic bronchoscopy to rule out associated lower airway lesions.

State-of-the-Art CT Imaging Techniques for Congenital Heart Disease

CT is increasingly being used for evaluating the cardiovascular structures and airways in the patients with congenital heart disease. Multi-slice CT has traditionally been used for the evaluation of the extracardiac vascular and airway abnormalities because of its inherent high spatial resolution and excellent air-tissue contrast. Recent developments in CT technology primarily by reducing the cardiac motion and the radiation dose usage in congenital heart disease evaluation have helped expand the indications for CT usage. Tracheobronchomalacia associated with congenital heart disease can be evaluated with cine CT. Intravenous contrast injection should be tailored to unequivocally demonstrate cardiovascular abnormalities. Knowledge of the state-of-the-art CT imaging techniques that are used for evaluating congenital heart disease is helpful not only for planning and performing CT examinations, but also for interpreting and presenting the CT image findings that consequently guide the proper medical and surgical management.