Anesthesiology | Medicine and Health Sciences | Respiratory System
Airway enlargement was first described histologically in 1872, but it was not clinically reported until 1932, when Dr. Mounier-Kuhn published his seminal radiographic studies.1 Since then, it is estimated that several hundred case reports have been published on congenital Mounier-Kuhn Syndrome (MKS), acquired tracheomegaly, and tracheobronchomegaly (TBM), yet only a few comprehensive literature reviews exist.2
This case report details an elective nasal procedure for a patient with a history of significant pulmonary hypertension ad COPD on 5L home O2 who had a symptomatic facial trauma. He was considered high risk secondary to his pulmonary disease, but he was considered medically optimized for surgery and had undergone a prior uncomplicated general anesthetic. An intraoperative endotracheal tube dislodgement necessitated emergency airway rescue with difficulty in re-establishing adequate ventilation resulting in the patient being brought to the ICU post-operatively. After a second endotracheal dislodgement shortly later, retrospective radiographic airway analysis revealed tracheal dimensions of 32 x 26mm, suggesting a previously undiagnosed tracheomegaly. Written consent and HIPAA authorization was obtained from the patient for the publication of this case report.
This case highlights the clinical importance for anesthesiologists to be aware of tracheobronchomegaly (TBM) despite limited provider experience with these patients and sparse reporting on the condition. It is underdiagnosed radiographically and may first present in the OR. TBM can manifest in many ways with potentially fatal complications thus it is vital for anesthesiologists to be able to recognize, troubleshoot, and potentially treat issues related to the disease.
Tracheobronchomegaly, tracheomegaly, Mounier-Kuhn Syndrome, endotracheal dislodgement, extubation, air leak, pressure leak, airway emergency, difficult airway
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Peck, A., Ghaly, T. N., Adams, A. J., Johnson, D. W., , Aron, R. A. Endotracheal Tube Dislodgment in a High Risk Pulmonary Hypertensive Patient due to Undiagnosed Tracheomegaly: A Case Report. Graduate Medical Education Research Journal. 2021 Dec 20; 3(2).