[Hydatid cyst in the cervical spinal cord complicated by potentially life-threatening difficult airway: a case report]. / Cisto hidático na medula cervical complicada por via aérea difícil com potencial risco de vida: relato de caso.

Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life-threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.

Hydatid cyst in the cervical spinal cord complicated by potentially life-threatening difficult airway: a case report / Cisto hidático na medula cervical complicada por via aérea difícil com potencial risco de vida: relato de caso

Abstract Hydatid cyst in the cervical region is an extremely rare condition that can create challenges for anesthesiologists. Timely recognition of difficult airway and preparing the management plan is crucial to avoid life-threatening complications such as hypoxic brain damage. We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst.

Resumo O cisto hidático na região cervical é uma condição extremamente rara que pode criar desafios para os anestesiologistas. O reconhecimento oportuno das vias aéreas difíceis e a preparação do plano de manejo são cruciais para evitar complicações com risco de vida, como danos cerebrais hipóxicos. Descrevemos um caso de difícil controle das vias aéreas em um paciente com cisto hidático cervical maciço. Utilizamos sedação com cetamina-propofol em baixa dose e spray de lidocaína para anestesia local orofaríngea. Relaxantes musculares não foram utilizados e a respiração espontânea foi mantida durante a intubação. O reconhecimento, a avaliação e o planejamento perioperatório são essenciais para o manejo difícil das vias aéreas em pacientes com cisto hidático cervical.

A Rare Cause of Hemoptysis: Oropharyngeal Leech

We report the case of a 33-year-old patient who presented with dyspnea and hemoptysis due to an oropharyngeal leech infestation. The patient was a shepherd and his detailed history revealed that he had been drinking water from natural springs. In the examination, a vivid dark green colored foreign body moving towards the nasopharynx and hypopharynx was detected in the oropharynx. The leech was removed under local anesthesia by gently grasping with the help of a long clamp. It should be noted that leeches are common in rural water sources and they can cause severe morbidity and even mortalities due to serious complications such as severe anemia and airway obstructions. A thorough oral and oropharyngeal examination will be sufficient to identify such cases, indicating the importance of physical examination in patients that present with otherwise unexplained airway obstruction and hemoptysis.

Tracheal rhinosporidiosis: an uncommon life threatening benign condition.

Rhinosporidiosis in tracheobronchial tree is extremely rare. It poses diagnostic and therapeutic challenges and has high chance of mortality because of presentation with respiratory distress. We report such a case of a 35 years old man who presented with respiratory distress and dry irritating cough. Fiberoptic laryngoscopy revealed a reddish soft tissue mass below the vocal cord level. Magnetic Resonance Imaging showed a soft tissue opacity within the trachea occluding the airway. Direct endoscopic biopsy was done after securing the airway. Histopathological examination confirmed rhinosporidiosis and the mass was excised through an external approach. The patient was free of symptoms and no recurrence was reported till 30 months of follow-up.

Leech infestation: the unusual cause of upper airway obstruction.

This paper presents a case of a 7 year-old child who presented with a 14-days history of blood stained saliva and shortness of breath of 3 days with signs of upper airway obstruction. Laryngoscopy revealed a blackish living foreign body in the proximal trachea. Under general anesthesia the leech was removed by applying forceps. I conclude that a high index of suspicion of leech infestation is required when faced with a child presenting with unexplained bleeding per mouth and signs of upper airway obstruction.

Surprising cause of respiratory distress in child: laryngeal leech.

Foreign body aspiration is a major problem that can cause respiratory distress and oral bleeding in a child. Leeches are rarely seen foreign bodies in the larynx. Generally, they live in springwater and can be aspirated by drinking. They can cause respiratory distress, oral bleeding, and anemia, if diagnostic process is delayed. When leeches are detected, urgent diagnosis and treatment are necessary. In this case, we present a 7-year-old child examined in the emergency service with these symptoms. A dark green living body in the larynx was detected and removed urgently under sedo-analgesia. The living body was seen as a leech that is 5 cm in length.

Aquatic leech as a rare cause of respiratory distress and hemoptysis.

This paper presents a 73 years old male with three weeks history of intermittent hemoptysis, dysphagia, dyspnea, stridor, and suffocations sensation. By means of fibrotic bronchoscopic examination, the cause was found to be a leech in the glottis. It was removed by injection of 4 ml lidocaine 2%. Infestation into the respiratory tract by a leech may become lethal because of hypoxia and death secondary to airway obstruction. A high index of suspicion of leech infestation sould be considered in patients presenting with hemoptysis, hoarseness and respiratory distress and a history of recent contact with fresh water streams.

Rhinosporidiosis of the upper airways and trachea.

OBJECTIVE: We report an extremely rare case of rhinosporidiosis with involvement of both larynx and trachea, together with coexisting nasal, nasopharyngeal and oropharyngeal lesions, in a 32-year-old man. METHOD: Case report and review of the world literature concerning laryngotracheal and disseminated rhinosporidiosis. RESULTS: A 32-year-old, South Indian man presented with a nasal mass of four years' duration, with progressive hoarseness for one year. Strawberry-like rhinosporidial masses were seen in both nasal cavities. Fibre-optic laryngoscopic examination revealed reddish masses with whitish surface specks, involving the glottis, subglottis and trachea. Computed tomography revealed soft tissue opacities involving both nasal cavities and the nasopharynx and extending to the oropharynx, with involvement of the larynx and trachea. Direct laryngoscopy and rigid bronchoscopy guided excision of the laryngeal and tracheal lesions was performed. CONCLUSION: Rhinosporidiosis is a chronic, granulomatous disease which usually affects the mucous membranes of the nose and nasopharynx. Lower dissemination into the trachea is extremely rare. Laryngotracheal involvement poses many diagnostic and therapeutic challenges, due to the potential risk of bleeding and aspiration. In the presented case, local spread of rhinosporidiosis, due to direct spillage of spores from the nasopharynx into the larynx during episodes of bleeding or previous surgery, may have resulted in laryngotracheal involvement, although systemic spread cannot be excluded.

VEGF promotes malaria-associated acute lung injury in mice.

The spectrum of the clinical presentation and severity of malaria infections is broad, ranging from uncomplicated febrile illness to severe forms of disease such as cerebral malaria (CM), acute lung injury (ALI), acute respiratory distress syndrome (ARDS), pregnancy-associated malaria (PAM) or severe anemia (SA). Rodent models that mimic human CM, PAM and SA syndromes have been established. Here, we show that DBA/2 mice infected with P. berghei ANKA constitute a new model for malaria-associated ALI. Up to 60% of the mice showed dyspnea, airway obstruction and hypoxemia and died between days 7 and 12 post-infection. The most common pathological findings were pleural effusion, pulmonary hemorrhage and edema, consistent with increased lung vessel permeability, while the blood-brain barrier was intact. Malaria-associated ALI correlated with high levels of circulating VEGF, produced de novo in the spleen, and its blockage led to protection of mice from this syndrome. In addition, either splenectomization or administration of the anti-inflammatory molecule carbon monoxide led to a significant reduction in the levels of sera VEGF and to protection from ALI. The similarities between the physiopathological lesions described here and the ones occurring in humans, as well as the demonstration that VEGF is a critical host factor in the onset of malaria-associated ALI in mice, not only offers important mechanistic insights into the processes underlying the pathology related with malaria but may also pave the way for interventional studies.

Ascaris lumbricoides infection causing respiratory distress after coronary artery bypass grafting.

BACKGROUND: Ascaris lumbricoides infects an estimated 1.2 billion people worldwide, but is usually asymptomatic. Herein we report a case of acute respiratory distress caused by upper airway obstruction due to an adult A. lumbricoides nematodes after cardiac surgery. METHODS: Case report and review of pertinent literature. CASE REPORT: A 70-year old female, until recently a resident of the rural Philippines, underwent coronary bypass grafting in New York City. Nine hours after surgery (one hour after endotracheal extubation), cough and arterial oxygen desaturation prompted airway suctioning, which retrieved an adult nematode from the posterior oroharynx. symptomes abated immediately, after which the patient receive a curative course of mebendazole. CONCLUSION: Although infection with A. lumbricoides is rare in the United States, it may become manifest with severe consequences in the postoperative period.

Death due to an unrecognized ascariasis infestation: two medicolegal autopsy cases.

Two unusual autopsy cases of fatal Ascaris infection have been presented. The first case presents lethal diffuse peritonitis due to duodenal rupture caused by the presence of parasitic Ascaris worm in gastrointestinal tract of 2.5-year-old child. The second one is a case of subacute asphyxia caused by obturation of upper respiratory tract by a large number of adult Ascaris roundworms. General economic crisis and inefficient medical service make possible spreading of almost eradicated disease, thus the possibility of the most serious complications of this helminthiasis must not be forgotten.

Rhinosporidiosis of trachea: a clinical cause for concern.

BACKGROUND: Rhinosporidiosis is a granulomatous infection usually affecting the nasal mucosa and conjunctiva. The disease is widely prevalent in India and Sri Lanka. Tracheo-bronchial involvement is extremely rare and is potentially life threatening. Diagnosis of tracheal involvement is a challenge due to the risk of bleeding during attempted bronchoscopic biopsy. CASE: A 73-year-old man was admitted with severe respiratory distress, for which emergency tracheostomy was performed. At tracheostomy, a fleshy mass was seen emerging from the wound. Pathological examination of the mass confirmed rhinosporidiosis involving the trachea. Complete excision of the mass was performed after initial stabilisation of the patient. CONCLUSION: Tracheo-bronchial rhinosporidiosis, a rare complication of nasopharyngeal infection, should be considered in a known case presenting with severe respiratory distress.

Pharyngeal bot flies in Cervus elaphus in central Spain: prevalence and population dynamics.

The prevalence and intensity of infestations by bot flies Pharyngomyia picta and Cephenemyia auribarbis in red deer (Cervus elaphus) from Quintos de Mora (Toledo, Spain) were determined over a 1-yr period. Bots were present all year. No clear correlations were found between age or sex of the host and parasitization levels (prevalence and intensity). Considerable variation was found in prevalence and intensity, with larger values from December to March. Cephenemyia auribarbis was restricted from November to March, with maximum numbers of L-3 in February. Pharyngomyia picta showed a more complex profile with 2 peaks (March and August), indicating 2 generations per year.

[Leeches in the respiratory system (author's transl)]. / Blutegel in den Atemwegen

The leech as a foreign body and parasite in the human respiratory tract occurs principally in the Mediterranean countries, in Africa and Asia. It reaches the respiratory tract when water is drunk directly from rivers, lakes, etc. Ignorance of this fact may cause diagnostic difficulties leading to errors in treatment. Anaemia and respiratory obstruction due to leeches cause danger to health and life, especially in children. Fatalities have been known. Treatment consists of endoscopic removal of the parasite, which may be technically difficult, especially when the leech is in the region of the larynx and thus presents dramatic conditions for the procedure. A series of 120 cases treated in Algeria between 1962 and 1971 is presented.