Supraglottic laryngeal sarcoidosis masquerading as supraglottitis.

Sarcoidosis is a rare multisystem disorder of unknown aetiology characterised by non-caseating granulomas in involved organs; it is a diagnosis of exclusion. Laryngeal involvement affects only 0.5%-5% of those with sarcoidosis. It is an uncommon but important cause of supraglottic inflammation and oedema and should be considered in the differential diagnosis in patients with supraglottitis. This case describes a 30-year-old man who presented with stridor and shortness of breath. Flexible nasendoscopic examination revealed a grossly oedematous, pale pink, diffusely hypertrophied epiglottis. Surgical biopsy revealed non-caseating granulomatous inflammation. In the context of exclusion of hepatitis, anti-neutrophil cytoplasmic antibody (ANCA) positivity, malignancy and mycobacterial infection, the diagnosis of supraglottic laryngeal sarcoid was made. He is being treated with azathioprine immunosuppression with symptomatic improvement.

Manejo De Vía Aerea Difícil En Paciente Con Tumor Supraglótico: Video-Laringoscopio Vs Fibrobroncoscopio Flexible / Endovascular treatment of aortoiliac occlusive disease by cerab

El manejo de la vía aérea ha sido tradicionalmente la situación más estresante que enfrenta el anestesiólogo en la práctica clínica habitual; A pesar de la existencia de varias guías y algoritmos, el manejo es complejo y el riesgo de resultados negativos con un compromiso vital para el paciente siempre está presente. En el caso de una vía aérea difícil previa o conocida, la actualización continua de estas guías es relevante, así como la introducción de nuevas técnicas y dispositivos que permiten un manejo más seguro y más eficiente cuando esta situación está presente. Aunque la intubación despierta con fibrobroncoscopia sigue siendo la técnica elegida, la llegada de las videolaringoscopias modernas puede ser una herramienta igualmente efectiva con una curva de aprendizaje más baja y puede combinarse con diversas técnicas de sedación o anestesia. Presentamos el caso clínico de un paciente con una vía aérea difícil conocida por el diagnóstico de tumor supraglótico y que rechaza una intubación despierta

The airway management have traditionally been the most stressful situation facing the anesthesiologist in usual clinical practice; despite the existence of various guides and algorithms the handling is complex, and de risk of negatives results with vital commit-ment to the patient is always present. In the case of previst or known difficult airway the continuous updating of these guides is rele-vant as well as the introduction of new techniques and devices that allow a seafer and more efficient handling when this situation is present. Although awake intubation with fibrobroncoscopy is still the technique of choice , the arrival of modern videolaringoscopys can be an equally effective tool with a lower learning curve and can be combined with various sedation or anesthesia tecniques.We present the clínical case of a patient with a difficult airway known for the diagno-sis of supraglottic tumor and who rejects an awake intubation

Routine computerised tomography in patients with acute supraglottitis for the diagnosis of epiglottic abscess: is it necessary?--a prospective, multicentre study.

OBJECTIVES: To evaluate the predictive factor of epiglottic abscess and to investigate whether routine computerised tomography (CT) in patients with acute supraglottitis are necessary. DESIGN: A prospective and multicentre study. SETTINGS: Tertiary care referral medical centre. PARTICIPANTS: A total of 202 patients with suspected acute supraglottitis were enrolled. All patients underwent CT to confirm the presence of abscess. MAIN OUTCOME MEASURES: The patients' characteristics, symptoms at presentation, laryngoscopic findings of epiglottic swelling and arytenoid swelling by scope classification and initial laboratory finding were analysed. RESULTS: Of 202 patients, 158 (78%) had acute supraglottitis and 44 (22%) had epiglottic abscess. There was no significant difference in age between the acute supraglottitis group and the epiglottic abscess group. Men were significantly more frequent in the epiglottic abscess group than females (P = 0.042). When comparing the symptom at presentation, the patients with epiglottic abscess complained of voice change more frequently (P = 0.003). Moderate or severe epiglottic swelling in scope classification was significantly associated with epiglottic abscess (P < 0.001). In logistic regression analysis, voice change [OR = 2.64, 95% CI = 1.29-5.40, P = 0.008] and moderate or severe epiglottic swelling in laryngoscopic findings [OR = 3.94, 95% CI = 1.63-9.53, P = 0.002] were independent predictive factors for epiglottic abscess. The positive predictive values of voice change and moderate or severe epiglottic swelling were 33% and 30%, respectively. The negative predictive values of voice change and moderate or severe epiglottic swelling were 15% and 9%, respectively. CONCLUSIONS: Routine CT might be suggested for diagnosis of epiglottic abscess in the patients with acute supraglottitis, because of the poor predictive values of symptoms and signs.