Fatal ball-valve airway obstruction by an extensive blood clot during mechanical ventilation

Abstract

Chest radiographs revealed overinflated lungs. Attempts to remove the cast via fibreoptic bronchoscopy were unsuccessful and the patient died. A postmortem extraction of the clot was performed with a rigid tube. This case is rare because of absence of severe haemoptysis and lung volume reduction.

Blood clot causing airway obstruction and the use of jet ventilation

“…A blood clot forming a ball-valve and obstructing the airway is very rare and potentially fatal [1]. This case highlights the difficulty in diagnosis and management of this condition, and the use of jet ventilation to improve the surgical view.…”

“…Intra-arterial injection via the dorsum of the hand is very rare, but has been reported [1,2]. Superficial arteries in the hand and forearm are though to occur in 1% of the population [3].…”

“…A variety of intraarterial chemical therapies have been recommended to prevent thrombosis and vasospasm, but no specific drug is strongly advocated [1].…”

“…We found six reports of ball-valve clot in four reports [1][2][3][4]. They can lead to rising intrathoracic pressures or pneumothorax [2] and possibly to fatal cardiac arrest [1].…”

“…We read with interest Cook's recent article concerning litigation relating to central venous catheter (CVC) access by anaesthetists [1]. We agree that complications from CVC insertion can be limited by reducing the number performed.…”