Search citation statements
Paper Sections
Citation Types
Year Published
Publication Types
Relationship
Authors
Journals
Background: Airway obstruction requires urgent intervention. When dealing with right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. Case presentation: A 38-year-old male patient presented with a three-day history of right neck swelling and neck pain, status post open repair of right subclavian artery pseudoaneurysm eight months ago. CT chest revealed a large right brachiocephalic artery pseudoaneurysm with partial thrombosis, associated tracheal compression and deviation. During initial work up, the cervical mass increased and the patient developed shortness of breath and hoarseness, necessitating urgent surgical intervention. Initially planned awake fiber-optic intubation was not feasible due to his uncooperative state and progressive respiratory distress. The femoral artery and vein was prepped in anticipation to promptly institute cardiopulmonary bypass in event of failed intubation and ventilation, or circulatory collapse. After Intravenous induction, mask ventilation with an oral airway was adequate. Endotracheal intubation was performed using a C-MAC D-Blade Video-laryngoscopy and an armored tube over a stylet. Though the laryngeal view was edematous and displaced to the left side, careful neck manipulations enabled successful intubation without desaturation. A bronchoscopy confirmed proper tube placement beyond the tracheal compression. EZ blocker was inserted for potential lung isolation. Despite the significant bleeding during the procedure, the surgical repair was successfully achieved. Post-operative ICU stay was uneventful. Video-laryngoscopy showed edematous aryepiglottic folds and was treated with methylprednisolone. The patient was successfully extubated after 48 hours. Conclusion Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes.
Background: Airway obstruction requires urgent intervention. When dealing with right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. Case presentation: A 38-year-old male patient presented with a three-day history of right neck swelling and neck pain, status post open repair of right subclavian artery pseudoaneurysm eight months ago. CT chest revealed a large right brachiocephalic artery pseudoaneurysm with partial thrombosis, associated tracheal compression and deviation. During initial work up, the cervical mass increased and the patient developed shortness of breath and hoarseness, necessitating urgent surgical intervention. Initially planned awake fiber-optic intubation was not feasible due to his uncooperative state and progressive respiratory distress. The femoral artery and vein was prepped in anticipation to promptly institute cardiopulmonary bypass in event of failed intubation and ventilation, or circulatory collapse. After Intravenous induction, mask ventilation with an oral airway was adequate. Endotracheal intubation was performed using a C-MAC D-Blade Video-laryngoscopy and an armored tube over a stylet. Though the laryngeal view was edematous and displaced to the left side, careful neck manipulations enabled successful intubation without desaturation. A bronchoscopy confirmed proper tube placement beyond the tracheal compression. EZ blocker was inserted for potential lung isolation. Despite the significant bleeding during the procedure, the surgical repair was successfully achieved. Post-operative ICU stay was uneventful. Video-laryngoscopy showed edematous aryepiglottic folds and was treated with methylprednisolone. The patient was successfully extubated after 48 hours. Conclusion Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes.
Airway obstruction requires urgent intervention. When dealing with the right brachiocephalic artery mycotic pseudoaneurysms, the risk of rupture and massive hemorrhage adds greater urgency to the management. Furthermore, tracheal compression presents difficulties during airway management. This report highlights the airway and anesthetic challenges encountered during the procedure and emphasizes the importance of tailored intervention for optimal patient care. We describe the clinical case of a 38-year-old male patient who presented with a large recurrent right brachiocephalic artery pseudoaneurysm associated with tracheal compression. The patient required urgent surgical intervention due to the pseudoaneurysm's enlargement and progressive respiratory distress. Awake fiber-optic intubation was not feasible. A cardiopulmonary bypass was kept on standby in the event of failed intubation and ventilation, or circulatory collapse. Endotracheal intubation was performed successfully using a video-laryngoscopy. After successful surgical repair of the pseudoaneurysm, the patient was transferred to ICU where he was extubated 48 hours post-surgery, following treatment with methylprednisolone for edematous aryepiglottic folds identified during video-laryngoscopy. Overall, this case emphasizes the importance of early diagnosis, prompt surgical intervention, and effective teamwork in managing rare and potentially life-threatening conditions like mycotic pseudoaneurysms. It also highlights the critical role of anesthesiologists in providing optimal perioperative care, ensuring hemodynamic stability, managing airway challenges, and facilitating successful surgical outcomes. In our work, we also provide a summary of the reported similar cases.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.