PubMed · 10723462
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N Schönfeld. 2000-02-25. [Interventional bronchoscopy].. https://pubmed.ncbi.nlm.nih.gov/10723462/
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Although tracheotomy-associated suprastomal granulation tissue is quite common, suprastomal granulation tissue that totally obstructs the airway is relatively rare and can be associated with serious complications. In this report the complications and management of six cases of totally obstructing suprastomal granulation tissue (TOSGT) are presented. Complications associated with the presence or management of TOSGT included progression of subglottic stenosis, development of posterior laryngeal stenosis, development of supraglottic stenosis following CO(2) laser supraglottoplasty, and dislodgement of the TOSGT with distal tracheal obstruction resulting in anoxic brain injury. It is recommended that the tracheotomy tube remains in position at all times during attempted removal, and that if endoscopic removal is not possible, that open tracheoplasty is the safest method for removal. Measures that may decrease the chances of recurrence include diligent diagnosis and treatment of gastroesophageal reflux disease (GERD) and bacterial infection. TOSGT may be a marker for some patients with abnormal wound healing.
Mycobacteria are being isolated with increasing frequency from automated bronchoscope disinfection machines. This has led to misdiagnosis and nosocomial infections. In this study, we isolated Mycobacterium chelonae from a bronchoscope disinfection machine and found one strain to be resistant to 2% glutaraldehyde and sensitive to 70% ethanol. Since we began cleaning the sink of the machine with 70% ethanol, no mycobacteria has been seen throughout the machine.
Otolaryngologists are frequently consulted to perform rigid bronchosopy in children with suspected foreign body aspiration, mucous plug occlusion of a mainstem or lobar bronchus, or other bronchial mass lesions. Chest radiographs that demonstrate unilateral lung or lobar collapse with a shift of mediastinal structures toward the affected side often prompt this referral. We describe 2 children, one with unilateral pulmonary agenesis and one with pulmonary aplasia, who presented with these radiologic findings. In each case, the definitive diagnosis was made at the time of bronchosopy. The diagnosis might have been suspected preoperatively if the chest radiographs had been reviewed with this clinical entity in mind. Because of its variable clinical presentation, diagnosis requires a high index of suspicion. Although computed tomography of the chest is diagnostic, the diagnosis may be suggested by chronic changes in the contralateral aspect of the chest wall and lung expansion on chest radiographs. Misdiagnosis may subject the patient to the unnecessary risks of bronchoscopy and to potential perforation of the rudimentary bronchus. Although pulmonary agenesis is a rare entity, it may mimic more common airway lesions. Therefore, unilateral pulmonary agenesis should be considered in the differential diagnosis of pediatric airway lesions. Arch Otolaryngol Head Neck Surg. 2000;126:1386-1389