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J Korean Soc Emerg Med > Volume 12(4); 2001 > Article
Journal of The Korean Society of Emergency Medicine 2001;12(4): 570-574.
Difficult Intubation due to Diffuse Type of Tracheo-bronchial Stenosis (complete tracheal rings) from Pulmonary Arterial Sling: A case report
Seok Ran Yeom, Jung Ho Shin, Jong Whan Shin, Gun Lee, Eell Ryoo, Sung Youl Hyun, Wook Jin, Jae Kwang Kim
Department of Emergency Medicine, Emergency Medical Center, Gachon Medical College, Incheon, Korea. youmori@hanmail.net
Pulmonary arterial sling, a rare developmental vascular anomaly forms a sling around the distal trachea and the proximal right main bronchus, where it sometimes makes tracheo-bronchial stenosis. Tracheobronchial stenosis from pulmonary arterial sling may produce non-specific symptoms of stridor, noisy breathing, dyspnea, recurrent upper respiratory tract infection, chronic cough, and dysphagia. The diagnosis of this anomaly begins with a high index of suspicion because of the lack of pathognomonic finding on usual evaluation. In this case, initial difficult intubation makes us evaluate further. Other cases reported the diagnosis is established by imaging studies, usually MRI and angiography. But, when our case was evaluated, we used cervico-thoracic enhanced computered tomography and tracheal fluoroscopy. Up to now, tracheobronchial stenosis from vascular anomaly is a rare and challenging disorder with a poor prognosis. However, early exact diagnosis would make us perform the accurate surgical treatment and reduce the mortality and morbidity.
Key words: Pulmonary sling, Tracheo-bronchial stenosis, Difficultintubation
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