Tuberc Respir Dis.  2011 Jul;71(1):59-61.

Obstructive Fibrinous Tracheal Pseudomenbrane Mimicking Tracheal Stents

• Kim JS
• Yu JH
• Kim YS
• Kim I
• Ahn JH

Abstract

Obstructive Fibrinous Tracheal Pseudomenbrane (OFTP) is a rarely known but potentially fatal complication of endotracheal intubation. Sudden respiratory failure shortly after extubation is not infrequent in the ICU. However, these cases are commonly diagnosed as laryngospasm, retention of secretion or laryngeal edema. A 68-year-old woman presented with a 6-day history of progressive dyspnea. She had undergone invasive ventilator care for 24 hours. The patient was discharged from the hospital with improvement after having an extubation. However, after 3 days she revisited the emergency department with progressive dyspnea. The patient was diagnosed with OFTP from the results of chest CT and bronchoscopy. This is the first case studied in detail using CT images, pulmonary function test, and bronchoscopy.

Keyword

Trachea; Airway Obstruction; Fibrin; Stents

MeSH Terms

Aged
Airway Obstruction
Bronchoscopy
Dyspnea
Emergencies
Female
Fibrin
Humans
Intubation, Intratracheal
Laryngeal Edema
Laryngismus
Respiratory Function Tests
Respiratory Insufficiency
Retention (Psychology)
Stents
Thorax
Trachea
Ventilators, Mechanical
Fibrin

Figure

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  Figure 1 Chest axial and coronal CT images are showing tubular structure with a good patency. It looks like a tracheal stents at upper trachea. CT: computed tomography.

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  Figure 2 (A) Fiberoptic bronchoscopy showing a thick tubular, rubber-like, whitish pseudomembrane moulding covering 2~3 cm of the tracheal wall at the level of the endotracheal cuff (the arrows indicate the pseudomembrane partially detached from trachea). (B) Fiberoptic bronchoscopy showing good patency after mechanical ablation with fiberoptic bronchoscopy.

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  Figure 3 Flow-volume loops showed a fixed airway obstruction before mechanical removal of OFPT (the arrows indicate flow-volume loops) (A) and complete recovery of a fixed airway obstruction after mechanical removal of OFPT (B).

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  Figure 4 Microscopic examination showing that the pseudomembrane consists of fibrinous material with acute inflammatory cell infiltration (H&E stain, ×100).

Reference

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4. Kang HH, Kim JW, Kang JY, Kim JS, Kim MS, Kim SS, et al. Obstructive fibrinous tracheal pseudomembrane after tracheal intubation: a case report. J Korean Med Sci. 2010. 25:1384–1386.