Oropharyngeal pleomorphic adenoma causing complete airway obstruction and cardiopulmonary arrest.
Oropharyngeal pleomorphic adenoma causing complete airway obstruction and cardiopulmonary arrest.
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DOI：
10.1093/omcr/omac083
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发表时间：
2022-08
影响因子：
0.5
通讯作者：
中科院分区：
文献类型：
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患者是一名住在养老院的85岁日本妇女，被诊断为硬腭多形性腺瘤。她已经不再去门诊了，因为腺瘤虽然扩大了，但没有症状。上呼吸道感染3天后，患者出现喘鸣、呼吸困难、心肺骤停。内部护士立即开始胸外按压和手动气囊通气，恢复自然循环。入院时，患者发现口咽间隙有一个巨大的弹性肿块（图1a，箭头）。由经验丰富的急诊医生通过直接喉镜检查获得Cormack 3级视图；然而，气管插管不成功。使用视频喉镜（气道镜®，Hoya, Tokyo, Japan）进行重复喉镜检查，提供Cormack 1级视野，允许用7.0 mm气管内管插管。计算机断层扫描显示一个均匀的肿块（5.4× 5.0× 3.5 cm）压迫口咽间隙（图1b箭头）。在接受气管切开术后，患者被转移到康复医院，没有神经系统后遗症。肿瘤的切除被推迟到她的运动状态通过康复得到改善。多形性腺瘤是一种常见的唾液腺肿瘤，约占所有唾液腺肿瘤的60%。临床表现包括吞咽困难[2]、声音嘶哑[3]、阻塞性睡眠呼吸暂停[4]。然而，这些病变可能是无症状的，如本例患者。多形性腺瘤引起的气道阻塞极为罕见[5,6]，据我们所知，没有相关的心肺骤停的报道。这个案例说明了两个要点。首先，即使是无症状的多形性腺瘤，叠加后也会造成完全的气道阻塞
The patient, an 85-year-old Japanese woman who was residing in a nursing home, had been diagnosed with a pleomorphic adenoma of the hard palate. She had stopped visiting an outpatient clinic because the adenoma, though enlarging, was asymptomatic. Three days after onset of an upper respiratory tract infection, she developed stridor and difficulty breathing and had a cardiopulmonary arrest. Chest compressions and manual bag ventilation were immediately initiated by in-house nurses, restoring spontaneous circulation. On admission to a hospital, she was found to have a huge elastic mass in her oropharyngeal space (Fig. 1a, arrow). A Cormack grade 3 view was achieved on direct laryngoscopy by an experienced emergency physician; however, endotracheal intubation was not successful. Repeat laryngoscopy with a video laryngoscope (Airway Scope®, Hoya, Tokyo, Japan) provided a Cormack grade 1 view, enabling intubation of her trachea with a 7.0-mm endotracheal tube. Computed tomography scan revealed a homogeneous mass (5.4× 5.0× 3.5 cm) compressing the oropharyngeal space (Fig. 1b, arrow). After undergoing a tracheostomy, the patient was transferred to a rehabilitation hospital with no neurological sequelae. Excision of the tumor was postponed until her performance status had been improved through rehabilitation. Pleomorphic adenoma is a common salivary gland tumor, accounting for∼ 60% of all salivary gland neoplasms [1]. Clinical manifestations include dysphagia [2], hoarseness [3] and obstructive sleep apnea [4]. However, these lesions may be asymptomatic, such as in this patient. Airway obstruction caused by a pleomorphic adenoma is extremely rare [5, 6] and, to our knowledge, there are no reports of associated cardiopulmonary arrest. This case illustrates two important points. First, even an asymptomatic pleomorphic adenoma can cause complete airway obstruction when superimposed on
影响因子：
1.7
作者：
Giddings, CEB;Bray, D;Williamson, P
通讯作者：
Williamson, P
影响因子：
3.4
作者：
Pinkston, JA;Cole, P
通讯作者：
Cole, P
影响因子：
1
作者：
Altunpulluk MD;Karabulut MH;Kır G;Şahin Ş
通讯作者：
Şahin Ş