Challenging differential diagnosis, Rare disease
Stefani M. Schwartz, Katherine J. Greco, Venugopal Reddy
(Department of Anesthesiology and Perioperative Medicine, Pennsylvania State College of Medicine/ Penn State Health Milton S. Hershey Medical Center, Hershey, USA)
Am J Case Rep 2017; 18:1005-1008
Pulmonary embolism is a common acute postoperative complication and is associated with 100,000 deaths per year in the USA. Tracheobronchomalacia is an uncommon condition, which presents with similar symptoms to pulmonary embolism, including hypoxemia, tachycardia, and shortness of breath. We describe a case of a patient who presented with postoperative pulmonary symptoms that were initially thought to be due to pulmonary embolism. However, following imaging investigations these symptoms were found to be due to tracheobronchomalacia.
CASE REPORT: A 73-year-old woman underwent elective ventral hernia repair and takedown of a Hartmann’s pouch. On the ninth postoperative day, she developed symptoms of acute respiratory distress and was admitted to the surgical intensive care unit. Respiratory function tests and blood gas evaluation showed that her alveolar-arterial oxygen gradient (A-a gradient) and modified Wells’ score were suggestive of a diagnosis of pulmonary embolism. A contrast-enhanced computed tomography (CT) scan of the lungs was negative for pulmonary embolism but demonstrated findings suggestive of tracheobronchomalacia.
CONCLUSIONS: Tracheobronchomalacia should be considered in the differential diagnosis of hypoxia when evaluating a patient in the ICU.
Keywords: Bronchoscopy, Pulmonary Embolism, Tracheobronchomalacia