Critical upper airway obstruction as the first symptom of acute myeloid leukemia - an anesthesiologic reminder

Acute upper airway obstruction can be fatal. Early recognition of airway distress followed by diagnostic laryngoscopy and prompt intervention to secure airway control is crucial. We here present a 62-year old male patient who presented with cough and increasing respiratory distress for three weeks. Within the next 24 h, he developed symptoms of critical upper airway obstruction, endotracheal intubation was not possible, and an acute surgical tracheotomy was performed to retain patent airways. A computer tomography scan revealed severe laryngopharyngeal soft tissue thickening and upper airway obstruction caused by leukemic infiltration. He was diagnosed with acute leukemia and responded to induction chemotherapy. This case report points out the importance of establishing the diagnosis of critical upper airway obstruction in patients presenting with respiratory symptoms, and highlights the emergency management of airway obstruction due to malignant infiltration of leukemic blasts.

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Using helium-oxygen mixtures in the emergency management of acute upper airway obstruction

Annals of Emergency Medicine ◽

10.1016/s0196-0644(89)80530-x ◽

1989 ◽

Vol 18 (6) ◽

pp. 688-690 ◽

Cited By ~ 32

Author(s):

Jeffrey M Boorstein ◽

Stephen M Boorstein ◽

Gary N Humphries ◽

Charles C Johnston

Keyword(s):

Emergency Management ◽

Airway Obstruction ◽

Upper Airway ◽

Upper Airway Obstruction

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Chronic Alveolar Hypoventilation Secondary to Macroglossia in the Beckwith-Wiedemann Syndrome

PEDIATRICS ◽

10.1542/peds.70.5.695 ◽

1982 ◽

Vol 70 (5) ◽

pp. 695-697 ◽

Cited By ~ 1

Author(s):

Dean F. Smith ◽

Frederick G. Mihm ◽

Michael Flynn

Keyword(s):

Pulmonary Hypertension ◽

Airway Obstruction ◽

Early Recognition ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Morbidity And Mortality ◽

Airway Compromise ◽

Alveolar Hypoventilation

Chronic upper airway obstruction has been shown to cause secondary reversible pulmonary hypertension. Many pathophysiologic processes can produce such obstruction. A 3-month-old child with Beckwith-Wiedemann syndrome who manifested chronic upper airway obstruction secondary to macroglossia is reported. Early recognition and therapy of airway compromise may decrease morbidity and mortality in this syndrome and others in which macroglossia is present.

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Acute upper airway obstruction caused by massive oedema of the tongue: unusual complication of sialoendoscopy

The Journal of Laryngology & Otology ◽

10.1017/s0022215109005647 ◽

2009 ◽

Vol 123 (12) ◽

pp. 1402-1403 ◽

Cited By ~ 2

Author(s):

P Baptista ◽

C V Gimeno ◽

F Salvinelli ◽

V Rinaldi ◽

M Casale

Keyword(s):

Airway Obstruction ◽

General Anaesthesia ◽

Upper Airway ◽

Upper Airway Obstruction ◽

Unusual Complication ◽

Major Salivary Gland ◽

Airway Control ◽

Inflammatory Conditions ◽

Life Threatening ◽

The Right

AbstractObjective:To underline the importance of accurate clinical evaluation of major salivary gland obstructions, in order to choose the right surgical approach and to reduce the risk of complications.Case report:We report a case of an unusual, previously unreported upper airway obstruction caused by massive swelling of the tongue following a successful sialoendoscopy, performed for treatment of submandibular sialolithiasis under general anaesthesia.Conclusions:Sialoendoscopy has gained popularity and is an accepted method for diagnosis and treatment of most inflammatory conditions of the major salivary glands. It can be performed as an out-patient procedure under local anaesthesia, and is not usually associated with significant complications. However, in the presence of larger stones (>4 mm) of the submandibular gland, we suggest that interventional sialoendoscopy should be performed under general anaesthesia with optimal airway control, in order to manage the major risk of perforations and ductal lesions enabling spread of saline solution into the mouth tissues and causing life-threatening swelling of the floor of the mouth and tongue.

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