Acute Respiratory Failure Caused by a Dilated Esophagus

Abstract

Introduction: We report a case of a 91-year-old woman with a history of esophageal dysmotility, who presented with acute respiratory distress triggered by tracheal compression from severe dilation of the esophagus and exacerbated by the use of NIPPV. A review of the literature demonstrated several cases of respiratory distress in patients using NIPPV with a history of achalasia, but our patient had only a history of esophageal dysmotility. It is important to recognize esophageal dysmotility as a risk factor for complications prior to using NIPPV. The recognition of this risk factor may modify a treatment approach and prevent respiratory failure and possible death from tracheal compression. Case Report: We report a 91-year-old woman with a history of poliomyelitis, kyphosis, CHF, and osteoporosis who was brought to the emergency room of a community hospital secondary to acuteonset shortness of breath. The patient had no prior symptoms except for mild dysphagia. There was no improvement of the patient’s oxygen saturation despite supplemental oxygen. An initial arterial blood gas was significant for severe respiratory acidosis. The initial chest x-ray and the EKG were unremarkable. A CT Chest with IV contrast demonstrated a markedly dilated esophagus with abundant debris in the distal esophagus. Given the severe respiratory acidosis with impending respiratory failure, the decision was made to use NIPPV. The patient’s clinical status worsened on NIPPV. At that point, we believed that the primary etiology of the patient’s respiratory failure was from tracheal compression due to the dilated esophagus, which was exacerbated by the NIPPV. The team secured the airway with endotracheal intubation and then proceeded with decompression of the esophagus with a naso-esophageal tube. Immediately, the patient’s clinical status improved so much that she was successfully extubated only 8 hours later and tolerated room air. Discussion: We believe that the patient’s esophageal dysmotility and the resulting esophageal dilation lead to the initial event, and the use of NIPPV created worsening dilation and compression of the trachea. This case highlights the importance to recognize esophageal dysmotility as a risk factor for tracheal compression when using NIPPV.Figure 1