Hemorragia masiva tras fístula arterio-esofágica por una arteria subclavia aberrante desconocida / Massive hemorrhage after arterioesophageal fistula from an unknown aberrant subclavian artery

La arteria subclavia derecha aberrante tiene una incidencia de un 0,5-1% en la población, con una localización generalmente retroesofágica. Puede llevar a la formación de una fístula arterio-esofágica en pacientes con factores de riesgo predisponentes por dispositivos colocados en posición esofágica o traqueal, al ser particularmente susceptible a la compresión extrínseca y a la necrosis por presión.Presentamos el caso de un paciente con una fístula traqueo-esofágica posquirúrgica, que desarrolló un sangrado masivo por una fístula arterio-esofágica secundaria a una arteria subclavia derecha aberrante desconocida. Para el manejo hemostático se realizaron maniobras alternativas, como la colocación de una sonda urinaria tipo Foley en el punto de sangrado y la posterior colocación de un balón de Sengstaken-Blakemore en posición craneal.Dada la gravedad del cuadro y el posible retraso diagnóstico, parece adecuado considerar la realización de un angio-TC preoperatorio en pacientes con factores de riesgo sometidos a estos procedimientos.(AU)

The aberrant right subclavian artery has an incidence of 0.5-1% in the population, generally with retroesophageal location. It can lead to the formation of an arterio-esophageal fistula in patients with predisposing risk factors due to devices placed in esophageal or tracheal position, as it is particularly susceptible to extrinsic compression and pressure necrosis.We present the case of a patient with a postsurgical tracheoesophageal fistula, who developed massive bleeding due to an arterioesophageal fistula secondary to an unknown aberrant right subclavian artery. For hemostatic management, alternative maneuvers were performed, such as the placement of a Foley-type urinary catheter at the point of bleeding and the subsequent placement of a Sengstaken-Blakemore balloon in cranial position.Given the severity of the condition and the possible diagnostic delay, it seems appropriate to consider performing a preoperative CT angiography in patients with risk factors who undergo these procedures.(AU)

Massive hemorrhage after arterioesophageal fistula from an unknown aberrant subclavian artery.

The aberrant right subclavian artery has an incidence of 0.5%-1% in the population, generally with retroesophageal location. It can lead to the formation of an arterio-esophageal fistula in patients with predisposing risk factors due to devices placed in esophageal or tracheal position, as it is particularly susceptible to extrinsic compression and pressure necrosis. We present the case of a patient with a postsurgical tracheoesophageal fistula, who developed massive bleeding due to an arterioesophageal fistula secondary to an unknown aberrant right subclavian artery. For hemostatic management, alternative maneuvers were performed, such as the placement of a Foley-type urinary catheter at the point of bleeding and the subsequent placement of a Sengstaken-Blakemore balloon in cranial position. Given the severity of the condition and the possible diagnostic delay, it seems appropriate to consider performing a preoperative CT angiography in patients with risk factors who undergo these procedures.

Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia.

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV-2 infection to the picture is pointed out.

Parálisis bilateral tardía de cuerdas vocales trasintubación endotraqueal por neumonía COVID-19 / Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia

La parálisis de cuerdas vocales es una complicación poco frecuente, aunque severa, tras una intubación orotraqueal. La causa más frecuente es la traumática, debido a la compresión del nervio laríngeo recurrente entre el maguito del tubo orotraqueal y el cartílago tiroides. Otras posibles causas son lesión directa de las cuerdas vocales durante la intubación, luxación de los cartílagos aritenoides e infecciones, sobre todo víricas. Suele deberse a una neuroapraxia del nervio laríngeo recurrente, y el curso es benigno en la mayoría de los pacientes. Presentamos el caso de un varón que desarrolló una parálisis de cuerdas vocales bilateral tras una neumonía complicada con distrés respiratorio por SARS-CoV-2 que requirió intubación orotraqueal durante 11 días. Presentó clínica de disnea a los 20 días del alta hospitalaria con desarrollo posterior de estridor, siendo necesaria la realización de una traqueostomía. Debido a la evoución temporal, se apunta una posible contribución de la infección por SARS-CoV-2 al cuadro.(AU)

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV- 2 infection to the picture is pointed out.(AU)

Late bilateral vocal cord palsy following endotracheal intubation due to COVID-19 pneumonia. / Parálisis bilateral tardía de cuerdas vocales trasintubación endotraqueal por neumonía COVID-19.

Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV- 2 infection to the picture is pointed out.