Tracheobronchomegaly in Intubated Ventilation of ARDS

Geng, Yanxia; Zhou, Jiang; Liu, Zhimin

doi:10.1016/j.arbres.2017.05.019

Archivos de Bronconeumología

ISSN: 0300-2896

Archivos de Bronconeumologia is an international journal that publishes original studies whose content is based upon results of research initiatives dealing with several aspects of respiratory medicine including epidemiology, respiratory physiology, pathophysiology of respiratory diseases, clinical management, thoracic surgery, pediatric lung diseases, respiratory critical care, respiratory allergy and translational research. Other types of articles such as editorials, reviews, and different types of letters are also published in the journal. Additionally, the journal expresses the voice of the following scientific societies: the Spanish Respiratory Society of Pneumology and Thoracic Surgery (SEPAR; https://www.separ.es/), the Latin American Thoracic Society (ALAT; https://alatorax.org/), and the Iberian American Association of Thoracic Surgery (AIACT; http://www.aiatorax.com/).

It is a monthly journal in which all manuscripts are sent to peer-review and handled by the editor or an associate editor from the team and the final decision is made on the basis of the comments from the expert reviewers and the editors. The journal is published solely in English. All the published data is composed of novel manuscripts not previously published in any other journal and not being in consideration for publication in any other journal..

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A 79-year-old man with a history of pulmonary fibrosis and Sjogren's syndrome was admitted to ICU for management of severe ARDS (Acute Respiratory Distress Syndrome) after radical prostatectomy. He presented with respiratory distress with bilateral opacities in chest radiograph (Fig. 1A). Tracheal intubation was performed the next day. However, the tidal volume continued to be instable at about 50–200ml even under fully sedation. A serious gas leakage was found as breath flow could be heard, which became better when head position fixed to the left. Taking back his history, he had had untreated tracheal abnormalities for decades. Chest computed tomography later showed diverticulum on both sides at the upper part of the trachea, and marked dilated trachea at the lower portion (Fig. 1B). Dueing to the poor attachment between the cuff of the endotracheal tube and the trachea wall, recruitment maneuvers for ARDS did not go well. The patient's condition continued to deteriorate and eventually died on the 11th day at ICU. Tracheobronchomegaly is a rare disease characterized by abnormally enlarged tracheo-bronchial tree. Chest X-ray may be misleading as it is easily overlooked on radiograph (Fig. 1A). Inexplicable poor ventilation in intubated patients should take into account the possibility of anatomic abnormalities, such as tracheobronchomegaly.

Fig. 1.

A) Chest X-ray at admission shows bilateral opacities and easily overlooked enlarged trachea (white arrow). B) Coronary computed tomography (CT) image showing diverticulums at proximal trachea. Diameters of distal trachea, right and left main bronchus were 36mm, 24mm, and 22mm respectively.