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Tracheal Disruption From Invasive Pretracheal Lymphadenopathy
Tracheal Disruption From Invasive Pretracheal Lymphadenopathy Hugh G. Auchincloss, MD, and Christopher R. Morse, MD Division of Cardiothoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts
Fig 1.
A
n 80-year-old man presented to the emergency department with cough, hoarseness, and midsternal chest pain. His medical history was notable for angioblastic T cell lymphoma that had previously been treated with low-dose prednisone. Recently he was found to have radiographic progression mediastinal lymphadenopathy thought to be related to his lymphoma. He developed a dry cough 2 weeks before presentation. This cough progressed and became persistent and painful. In the hours preceding presentation, the cough had become intractable and he noted worsening hoarseness and chest pain. His oxygen saturation was 93% on 10 L of supplemental oxygen. He was dyspneic and hoarse between paroxysms of coughing. He had no neck or chest wall crepitance. Computed tomography revealed that a pretracheal
Address correspondence to Dr Auchincloss, The Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Charles River Plaza, Ste 403, Boston, MA 02114; e-mail: hauchincloss1@ partners.org.
© 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
lymph node measuring 3.4 cm was eroding into the patient’s trachea (Fig 1A) and right mainstem bronchus (Fig 1B), resulting in pneumomediastinum. The patient was brought emergently to the operating room. The images in Fig 1 were obtained on bronchoscopy. Beginning 2.5 cm above the carina, the anterior trachea was frankly necrotic. There was a defect in the cartilaginous wall extending to the membrocartilaginous junction on the right and comprising approximately 70% of the circumference. The defect extended into the right mainstem and upper lobe bronchi. Surgical repair was not feasible due the extent of the defect. The patient was awakened from anesthesia and brought to the intensive care unit, where he died in the company of his family. Tracheal rupture from trauma, intubation, or injury during neck or mediastinal surgery have been described. However, no reports of tracheal disruption from invasive pretracheal lymphadenopathy exist in the literature.
Ann Thorac Surg 2013;95:e23 • 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2012.07.070
Fig 1.
A
n 80-year-old man presented to the emergency department with cough, hoarseness, and midsternal chest pain. His medical history was notable for angioblastic T cell lymphoma that had previously been treated with low-dose prednisone. Recently he was found to have radiographic progression mediastinal lymphadenopathy thought to be related to his lymphoma. He developed a dry cough 2 weeks before presentation. This cough progressed and became persistent and painful. In the hours preceding presentation, the cough had become intractable and he noted worsening hoarseness and chest pain. His oxygen saturation was 93% on 10 L of supplemental oxygen. He was dyspneic and hoarse between paroxysms of coughing. He had no neck or chest wall crepitance. Computed tomography revealed that a pretracheal
Address correspondence to Dr Auchincloss, The Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Charles River Plaza, Ste 403, Boston, MA 02114; e-mail: hauchincloss1@ partners.org.
© 2013 by The Society of Thoracic Surgeons Published by Elsevier Inc
lymph node measuring 3.4 cm was eroding into the patient’s trachea (Fig 1A) and right mainstem bronchus (Fig 1B), resulting in pneumomediastinum. The patient was brought emergently to the operating room. The images in Fig 1 were obtained on bronchoscopy. Beginning 2.5 cm above the carina, the anterior trachea was frankly necrotic. There was a defect in the cartilaginous wall extending to the membrocartilaginous junction on the right and comprising approximately 70% of the circumference. The defect extended into the right mainstem and upper lobe bronchi. Surgical repair was not feasible due the extent of the defect. The patient was awakened from anesthesia and brought to the intensive care unit, where he died in the company of his family. Tracheal rupture from trauma, intubation, or injury during neck or mediastinal surgery have been described. However, no reports of tracheal disruption from invasive pretracheal lymphadenopathy exist in the literature.
Ann Thorac Surg 2013;95:e23 • 0003-4975/$36.00 http://dx.doi.org/10.1016/j.athoracsur.2012.07.070