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Assembly

Clogged Pipe

Authors
Sarah Orfanos MD, Ibrahim El Husseini MD
Division of Pulmonary and Critical Medicine, Rutgers Robert Wood Johnson University Hospital.


Case

A 25-year-old female presented to the intensive care unit for altered mental status following a suicidal attempt and ingestion of an unknown substance. Patient was intubated for airway protection and treated with Fomepizole and hemodialysis and extubated within 24 hours. A few hours post-extubation, she developed inspiratory and expiratory stridor requiring reintubation. Computed tomography (CT) of the chest (Figure 1) and flexible bronchoscopy (Video 1) were performed for further evaluation.

Figure 1: Post-extubation coronal computed tomography of the chest (parenchymal window)
Figure 1: Post-extubation coronal computed tomography of the chest (parenchymal window)
Video 1: Diagnostic bronchoscopy with visualization of the trachea
Video 1: Diagnostic bronchoscopy with visualization of the trachea

Question

What is the etiology of the patient’s persistent stridor and respiratory distress?

A. Tracheomalacia
B. Post-intubation tracheal granuloma
C. Tracheal caustic injury
D. Tracheal tumor
E. Tracheo-esophageal fistula

Answer