Embryonic metastatic rhabdomyosarcoma compressing the trachea.

Abstract

Sir, Eleven year old girl presented to the intensive care unit, Krishna institute of medical sciences Hyderabad in September 2014 with shortness of breath, tachypnea, tachycardia. History revealed rhabdomyosarcoma for which chemotherapy was taken and symptom free period of one year followed by the present complaint. History of progressive dysphagia to liquids and solids for one month was given by parents. On auscultation of the chest, bilateral crepitations were heard. Arterial Blood Gas analysis revealed severe hypoxemia, hypocarbia. Furosemide was given, followed by nebulisation and Noninvasive ventilation BiPAP was instituted. Chest X-ray [Table/Fig-1] revealed severe narrowing of the trachea due to nodal compression. Endoscopy revealed submucosal bulge from posterior pharyngeal wall (left side). Computerised tomographic scan of chest [Table/Fig-2] revealed severe narrowing of the trachea. Airway examination revealed Mallampati class 4 [1] . Emergency endotracheal intubation was done in the operating room to save her from hypoxic injury and supported with ventilator. Palliative radiation was started to relieve compression. Significant pleural effusion was detected which were drained periodically mean while. Pancytopenia due to marrow infiltration was suspected as disease surfaced at several places in the lung and liver. After seven days, she developed hypotension and remained unresponsive to vasopressor which led to cardiorespiratory arrest. [Table/Fig-1]: Chest X-ray showing compression of trachea [Table/Fig-2]: Computerised tomographic scan of chest showing narrowing of trachea