Tuberc Respir Dis.  2009 Aug;67(2):140-144.

A Case of Tracheal Carcinoma Diagnosed by Rigid Bronchoscopy in Lidocaine Anaphylaxis Patient

• Yoon BK
• Ban HJ
• Kwon YS
• Oh IJ
• Kim KS
• Kim YI
• Lim SC
• Kim YC
• Song SY

Abstract

The majority of flexible bronchoscopies are performed under topical anesthesia with lidocaine being the most commonly used agent. Anaphylaxis rarely occurs after local administration of lidocaine, but can be a fatal complication. We experienced a case of unexpected anaphylaxis. A 66-year-old woman was scheduled for flexible bronchoscopy to evaluate a tracheal mass and stenosis. The oral and nasal mucosa were pretreated with lidocaine. About 2~3 minutes later, the patient developed hypotension and we treated for anaphylaxis in the emergency room. Then, we decided to perform rigid bronchoscopy in this patient, under conditions of general anesthesia. A rigid bronchoscopy was performed in this patient, safely and successfully. The tracheal mass was determined to be squamous cell carcinoma.

Keyword

Lidocaine anaphylaxis; Rigid bronchoscopy; Flexible bronchoscopy

MeSH Terms

Aged
Anaphylaxis
Anesthesia
Anesthesia, General
Bronchoscopy
Carcinoma, Squamous Cell
Constriction, Pathologic
Emergencies
Female
Humans
Hypotension
Lidocaine
Nasal Mucosa
Lidocaine

Figure

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  Figure 1 Chest X-ray shows a lower tracheal stenosis (arrow) by circumferential mass.

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  Figure 2 Chest computed tomography shows a tracheal stenosis by irregular hypertrophy of lower endotracheal wall.

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  Figure 3 (A) Bronchoscopic finding shows a tracheal stenosis by irregular endotracheal mass in lower trachea. (B) This shows Karl Storz endoskope set. (C) This bronchoscopic finding shows that rigid bronchoscopy was performed to reestablish patency of the airway by means of mechanical removal. An arrowhead shows a tip of rigid bronchoscope. (D) Normal orifices of both main bronchi are seen.

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