Rationale: Subglottic tracheal stenosis is stenosis of the trachea between the vocal cords and the lower margin of the cricoid cartilage. The Montgomery T-tube is used as a tracheostomy tube and a combined tracheal stent to avoid postoperative tracheal stenosis. Patient concerns: Because the stenosis is close to the glottis, surgical treatment is complex, and many complications may arise. Diagnoses: Subglottic tracheal stenosis. Interventions: The patients underwent endotracheal intubation or tracheotomy because of acute pancreatitis, laryngeal malignancy, or cerebral hemorrhage after endotracheal intubation or tracheotomy and presented with varying degrees of tracheal stenosis and dyspnea. We relieved airway stenosis and improved dyspnea in these 3 patients by placing a Montgomery T-tube. Outcomes: None of the 3 patients had intraoperative complications. In 2 of the cases, airway secretions were stored after surgery. Lessons: Montgomery T-tube placement is safe and effective for patients with complex subglottic tracheal stenosis.
Gorham–Stout syndrome is a sporadic condition characterized by a tumor-like lesion with extensive osteolysis, severe symptoms, and a poor prognosis. Poor prognostic indicators include osteolytic lesions of the spine and pleura effusion. We presented a case in which the condition first manifested itself at the age of 67, with exacerbated shortness of breath. The patient's imaging studies (CT scan, MRI, and PET/CT) revealed osteolytic lesions (the skull, several spines, several ribs, both shoulder blades, and the pelvis). After a tissue biopsy of the spine, postoperative pathology revealed that a portion of the bone had been replaced by lymphatic-derived endothelial cells that stained positive for D2-40. The tests permitted parasitosis, thyroid or parathyroid disease, parasitosis, lymphoma, neoplasia, or an autoimmune problem to be ruled out. On the patient, we performed a superior vena cava angiography. There was an abnormal expansion of the azygos vein into the superior vena cava, as well as local contrast agent retention. The injection of zoledronic acid was used to prevent bone loss. After the therapy, his shortness of breath was greatly reduced. He experienced ongoing shortness of breath alleviation during the 2-month follow-up visit.
Rationale: Gorham-Stout syndrome is a sporadic condition characterized by a tumor-like lesion with extensive osteolysis, severe symptoms, and a poor prognosis. Poor prognostic indicators include osteolytic lesions of the spine and pleura effusion.Patient concerns: A 67-year-old Chinese man with five months history of chest tightness presented to our institution with aggravated shortness of breath. Ultrasonography demonstrated hydrothorax on the right side. The patient's imaging studies (computerized tomography [CT] scan, magnetic resonance imaging, and positron emission tomography [PET]/CT) revealed osteolytic lesions (the skull, several spines, several ribs, both shoulder blades, and the pelvis).Diagnoses: Gorham-Stout syndrome. (4) Interventions: We advised the patient to follow a low-fat diet. On the patient, we performed a superior vena cava angiography. The injection of zoledronic acid was used to prevent bone loss.Outcomes: We found resolution of chylothorax after a low-fat diet, superior vena cava angiography and injection of zoledronic acid.Lessons: The possibility of Gorham -Stout syndrome should be ruled out in patients with clinical chylothorax. The relief of chylothorax requires comprehensive treatment.
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