Exuberant Intratracheal Granuloma

Emelia Stuart,Kayva Crawford,Michael Armaneous,David Bracken,Andrew M Vahabzadeh-Hagh

doi:10.1155/2021/6697478

Emelia Stuart, Kayva Crawford + Show 3 more

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https://doi.org/10.1155/2021/6697478

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Abstract

Background Upper airway granulomas are commonly encountered benign masses and are a result of pronounced tissue reactivity to localized respiratory mucosal trauma. The mechanism of injury to respiratory epithelium is most commonly iatrogenic and associated with intubation or indwelling tracheostomy. Case Report. A 40-year-old obese female with a history of multiple intubations, poorly controlled diabetes mellitus type II, and history of tracheal stenosis presented with sudden onset respiratory distress requiring intubation at an outside hospital. Direct laryngoscopy revealed a rapidly forming transglottic tissue mass, measuring 5.0 × 2.2 × 0.8 cm. The following case represents an unusual exception to our experience with granulomas given its rapidity of onset and migration of tissue around the endotracheal tube. Discussion. Laryngeal erythema and granulation formation are expected postintubation findings in most patients; however, the large size of granuloma tissue and rapid onset of symptoms in this case make it remarkable. Our patient had multiple risk factors for postintubation stenosis: female sex, poorly controlled diabetes, hypertension, obesity, and multiple prior intubations for periods lasting longer than forty-eight hours. Conclusion Our case highlights a rare laryngeal finding of a large granulation tissue mass causing sudden onset airway obstruction.

Highlights

Vocal process granulomas are benign lesions found in the posterior glottis [1, 2]
Risk factors associated with the development of laryngeal granulomas after intubation include female sex, prolonged intubation, traumatic intubation, inappropriate tube size, high cuff pressures, and presence of a concurrent nasogastric tube
In addition to granuloma formation, prolonged intubation is the leading cause of tracheal stenosis. e most common site for postintubation tracheal stenosis occurs at the cuff site and is attributed to localized tissue ischemia secondary to pressure [8]

Summary

Background

Upper airway granulomas are commonly encountered benign masses and are a result of pronounced tissue reactivity to localized respiratory mucosal trauma. e mechanism of injury to respiratory epithelium is most commonly iatrogenic and associated with intubation or indwelling tracheostomy. Upper airway granulomas are commonly encountered benign masses and are a result of pronounced tissue reactivity to localized respiratory mucosal trauma. A 40-year-old obese female with a history of multiple intubations, poorly controlled diabetes mellitus type II, and history of tracheal stenosis presented with sudden onset respiratory distress requiring intubation at an outside hospital. Laryngeal erythema and granulation formation are expected postintubation findings in most patients; the large size of granuloma tissue and rapid onset of symptoms in this case make it remarkable. Our patient had multiple risk factors for postintubation stenosis: female sex, poorly controlled diabetes, hypertension, obesity, and multiple prior intubations for periods lasting longer than forty-eight hours. Our case highlights a rare laryngeal finding of a large granulation tissue mass causing sudden onset airway obstruction

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Case Description

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