Streptococcus bovis endocarditis presenting with gastrointestinal bleeding

Abstract

thesis. lo Tracheal narrowing by the proximal end of the tube was demonstrated in that patient by esophagram, but no further respiratory difficulty occurred after endotracheal extubation. The sequence of events in our patient suggests that prosthesis placement led to air flow obstruction of the distal trachea or right mainstem bronchus. The onset of respiratory difficulty coincided with the insertion of the prosthesis across the esophageal narrowing. Reversal of hypoxemia and high peak inspiratory flow pressures upon removal of the prosthesis further implicate the prosthesis as causing extraluminal obstruction of the trachea or right mainstem bronchus. Pulmonary flow volume curves can document fixed obstruction, but it is uncertain whether such measurements could have predicted this complication since no fixed obstruction of the trachea or right mainstem bronchus was found at autopsy. In patients with extraluminal esophageal compression secondary to pulmonary malignancy, esophageal prosthesis insertion should be approached with caution.