Acute and Critical Care

Case Reports

Pulmonary
Lobar Bronchial Rupture with Persistent Atelectasis after Blunt Trauma: Jun Hyun Kim, Kyung Woo Kim, Chu Sung Cho, Sang Il Lee, Ji Yeon Kim, Kyung Tae Kim, Won Joo Choe, Jang Su Park, Jung Won Kim; Korean J Crit Care Med. 2014;29(4):344-347. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.344

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Abstract PDF: Rupture limited to the lobar bronchus from blunt trauma is especially rare, and the symptoms are light so diagnosis is difficult. In a patient who visited the hospital complaining of shortness of breath after falling down, atelectasis continued in the chest x-ray. Four days after visiting the hospital, a left upper lobar bronchial rupture was diagnosed through a bronchoscopy and 3 dimensional chest computerized tomography. When diagnosis is delayed in the case of a rupture limited to the lobar bronchus, bronchial obstruction can occur from the formation of granulation tissue, so regular monitoring is important. Therefore, when atelectasis continues after blunt trauma, it is important to differentially diagnose a lobar bronchial rupture through tests such as bronchoscopy.

Pulmonary
Obstructive Fibrinous Tracheal Pseudomembrane Presented with Atelectasis: Jick Hwan Ha, Hyewon Lee, Young Jae Park, Hyeon Hui Kang, Hwa Sik Moon, Sang Haak Lee; Korean J Crit Care Med. 2014;29(2):110-113. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.110

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Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare condition usually associated with endotracheal intubation. Airway obstruction caused by OFTP may occur after endotracheal tube extubation and can lead to severe respiratory distress. It is a rare but potentially fatal complication. In this report, we present a case of OFTP presented with atelectasis that caused dyspnea after extubation and was successfully treated by mechanical removal using a rigid bronchoscope.

Citations

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Obstructive Fibrinous Tracheal Pseudomembrane
Yoann Ammar, Juliette Vella-Boucaud, Claire Launois, Hervé Vallerand, Sandra Dury, François Lebargy, Gaëtan Deslee, Jeanne-Marie Perotin
Anesthesia & Analgesia.2017; 125(1): 172. CrossRef
Obstructive Fibrinous Tracheal Pseudomembrane: An Update
Alberto Manassero, Matteo Bossolasco
Korean Journal of Critical Care Medicine.2014; 29(3): 241. CrossRef

Airway Obstruction and Respiratory Failure Due to Aspergillus Tracheobronchitis: Yousang Ko, So Yeon Lim, Gee Young Suh, Kyeongman Jeon, Seo Goo Han; Korean J Crit Care Med. 2013;28(1):67-71.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.67

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Abstract PDF

Invasive aspergillosis is a serious threat and a leading cause of death in immunocompromised patients. Aspergillus tracheobronchitis is an infrequent but severe form of invasive pulmonary aspergillos in which the fungal infection is entirely or predominantly confined to the tracheobronchial tree. We report an extraordinary case of acute airway obstruction and respiratory failure due to Aspergillus tracheobronchitis in an immunocompromised patient. Fiberoptic bronchoscopy revealed extensive obstruction of both the main and lobar bronchus with yellowish nodules strongly adhered to the bronchial wall; both histologic examination and culture of these nodules revealed Aspergillus fumigatus. Even with early detection of an intraluminal growth of Aspergillus and prompt institution of antifungal therapy, the patient died of refractory hypoxemia a few days later. This report shows that Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis.

Citations

Citations to this article as recorded by

Death due to Aspergillus Tracheobronchitis: An Autopsy Case
Tack Kune You, Byung Ha Choi, Bong Woo Lee, Young Shik Choi
Korean Journal of Legal Medicine.2018; 42(4): 164. CrossRef

Original Article

Atelectasis and the Risk Factors in the Patients Admitted to Pediatric Intensive Care Unit: Woo Jin Chung, Jae Wook Choi, Young Ju Han, Ju Kyung Lee, Dong In Suh, Young Yull Koh, June Dong Park; Korean J Crit Care Med. 2011;26(4):238-244.; DOI: https://doi.org/10.4266/kjccm.2011.26.4.238

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Abstract PDF: BACKGROUND
Atelectasis is a state of a collapsed and non-aerated region of the lung parenchyma, which is otherwise normal. This condition is usually associated with pulmonary disorders. The purpose of this study is to analyze the incidence and risk factors of atelectasis in patients admitted to the pediatric intensive care unit (PICU).
METHODS
We retrospectively analyzed the clinical characteristics and chest radiography of 280 PICU patients under 18 years old. We analyzed the incidence and pattern of atelectasis and compared the incidence according to the phase and mode of mechanical ventilation. We compared the incidence of ventilator care need and respiratory disease in 93 atelectasis patients.
RESULTS
Atelectasis incidence was 33.2%. The age (4.9 +/- 4.4 years) was younger and the admission-duration (17.8 +/- 25.1 days) was significantly longer in atelectasis patients (p < 0.01). Ventilator care need and respiratory disease in atelectasis patients (86.0%, 66.7% respectively) was significantly higher than in non-atelectasis patients (62.6%, 43.3% respectively) (p < 0.01). Atelectasis incidence in ventilator-required patients and respiratory-diagnosed patients (40.6%, 43.4% respectively) was significantly higher than that in non ventilator-required patients and non respiratory-diagnosed patients (15.7%, 22.6% respectively) (p < 0.01). Atelectasis was more common in the right upper lobe (55.6%) and during or after ventilator care (62.6%) (p < 0.05). Atelectasis incidence in ventilator care did not differ between the assist-control and intermittent mandatory ventilation modes.
CONCLUSIONS
In the PICU, atelectasis incidence was higher in patients with ventilator care and respiratory disease. Atelectasis was more common in the right upper lobe and in the phase after ventilator initiation. Atelectasis incidence in ventilator care did not differ between ventilation modes.

Case Report

Atelectasis of Dependent Lungs during Fistula Closure in a Patient with Tracheopleural Fistula: A Case Report: Hong Soo Jung, Yeon Soo Jeon, Jin Woo Choi, Jin Deok Joo, Yong Shin Kim, Dae Woo Kim, Jang Hyeok In, Joo Seon Park; Korean J Crit Care Med. 2009;24(2):106-110.; DOI: https://doi.org/10.4266/kjccm.2009.24.2.106

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Abstract PDF: Atelectasis is a fairly common complication in patients undergoing general anesthesia. However, atelectasis caused secretion plugs in patients with tracheopleural fistula is less common than other airway fistulas such as trachea and bronchus. Anesthesiologists should make every effort for thorough preoperative preparation to prevent atelectasis and using appropriate and aggressive treatment, including tracheal or bronchial clearing and end expiratory positive pressure. We report a case of an intraoperative occurrence of atelectasis of the lower lobe of a dependent lung in a patient with a tracheopleural fistula during single lung ventilation for primary closure.

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