Severe Laryngeal Edema Research Articles

Assessment of emergency physicians’ awareness and knowledge of hereditary angioedema

Aims: Hereditary angioedema can occur with life-threatening attacks of severe laryngeal edema, and epinephrine is insufficient in the treatment of attacks. We sought an answer to the question, 'Do emergency physicians, who frequently encounter angioedema cases that are so important for the emergency department, have sufficient awareness about this issue?' Methods: In this study, the online questionnaire was conducted among physicians working in adult emergency departments between April and August 2022. The questionnaire form consisted of two parts. The first part contained three questions about medical experience, academic degree, and encounter with hereditary angioedema patients. The second part of the questionnaire contained seven questions about the diagnosis and treatment of hereditary angioedema. Results: A total of 103 physicians working in emergency departments participated in the survey. The proportion of physicians is as follows: The percentage of physicians with less than 15 years of experience was 92.2%. Research assistants represented the largest group of participants at 51.5%. When asked "What is not a symptom of hereditary angioedema?" Only 40.6% of physicians could answer the question correctly. While 39.8% of physicians thougt that epinephrine and antihistamines were useful in treating these attacks, 53.4% felt that epinephrine and antihistamines were not. While there was a difference in hereditary angioedema awareness between the group with more than 15 years of professional experience and the group with less experience, there was no meaningful difference between research assistants, specialists, and academicians. According to this survey, professional experience was important, but academic title did not make a difference in terms of disease awareness. Conclusion: It is necessary to increase the awareness of emergency physicians about hereditary angioedema, which can cause fatal attacks and whose diagnosis and treatment are different from other angioedemas.

Chronic Severe Laryngeal Inflammation Caused by Basidiobolomycosis

Basidiobolomycosis is an uncommon fungal infection primarily found in plants. In humans, it typically affects the skin and gastrointestinal tract on manifestation of the infection. A 29-year-old female presented to our clinic with complaints of shortness of breath and voice changes. On examination, she exhibited severe laryngeal edema. She was initially diagnosed with type 3 hereditary angioedema with a normal C1 inhibitor and later as a case of laryngeal sarcoidosis, treatment for both conditions proved ineffective. Ultimately, after further microbiological assessment, she was diagnosed with chronic granulomatous laryngeal fungal infection caused by the Basidiobolus species. Subsequently, she displayed significant improvement with itraconazole treatment. Chronic laryngeal edema can have various underlying causes. This case underscores the importance of considering fungal pathogens, especially rare ones when assessing such conditions. In cases where the diagnosis is uncertain or standard treatments are ineffective, patient reassessment and repeated laryngeal biopsies are essential.

Management of malignant superior vena cava syndrome.

Superior vena cava (SVC) syndrome occurs due to obstructed blood flow through the SVC. It can present clinically on a spectrum, between asymptomatic and life-threatening emergency. Patients commonly report a feeling of fullness in the head, facial, neck and upper extremity edema, and dyspnea. On imaging, patients commonly have superior mediastinal widening and pleural effusion. The majority of cases are due to malignant causes, with non-small cell lung cancer, small cell lung cancer, and lymphoma the most commonly associated malignancies. When evaluating patients, a complete staging workup is recommended, as it will determine whether treatment should be definitive/curative or palliative in intent. If the patient requires urgent treatment of venous obstruction, such as in the cases of acute central airway obstruction, severe laryngeal edema and/or coma from cerebral edema, direct opening of the occlusion by endovascular stenting and angioplasty with thrombolysis should be considered. Such an approach can provide immediate relief of symptoms before cancer-specific therapies are initiated. The intent of treatment is to manage the underlying disease while palliating symptoms. Treatment approaches most commonly employ chemotherapy and/or radiation therapy depending on the primary histology. Mildly hypofractionated radiation regimens are most commonly employed and achieve high rates of symptomatic responses generally within 2 weeks of initiating therapy.

Three Cases of Persistent Laryngeal Edema Postradiation Therapy

Radiation therapy (RT) for head and neck cancer, which has made remarkable progress in recent years, is one of the main treatment modalities because it can preserve organ function and morphology after treatment. However, while RT is widely used, complications have been reported, especially laryngeal edema, which can be an airway management problem during general anesthesia. Of the 3 cases of RT-induced laryngeal edema presented here, the first developed 4 days post-RT, the second manifested signs and symptoms associated with laryngeal edema after RT performed 4 years and 4 months previously, and the third exhibited severe laryngeal edema over a decade post-RT despite the absence of clinical signs and symptoms. Patients with a previous history of RT involving the head and neck region may encounter challenges in airway management due to laryngeal edema. Therefore, it is crucial to assess the airway preoperatively and devise a comprehensive airway management plan that encompasses various devices and techniques.

Supraglottic myxoedema successfully treated orally.

Myxoedema coma is a severe form of hypothyroidism with multiple organ dysfunction, characterised by an altered state of consciousness and hypothermia. Intravenous thyroid hormone replacement therapy is the preferred treatment for myxoedema. The mortality rate associated with this disease is high, and early detection and intervention are essential. Supraglottal myxoedema is a rare form of periglottic oedema and can be fatal. A previously healthy 66-year-old man presented with impaired consciousness, hypothermia, and nonpitting oedema. Blood tests revealed the presence of hypothyroidism and respiratory acidosis. He was intubated for type 2 respiratory failure; however, severe laryngeal oedema made the procedure difficult to perform. Oral thyroid hormone therapy was initiated under the diagnosis of myxoedema coma. Tracheostomy was performed because of prolonged type 2 respiratory failure and laryngeal oedema. Three weeks after admission, the patient was weaned off the ventilator. Approximately a week later, laryngeal oedema improved, and the tracheostomy tube was removed. The patient was discharged and remained stable for 3 months. This case report describes a patient with comatose myxoedema and supraglottic oedema who was successfully treated with oral medication alone. This case shows that supraglottic oedema should be considered even in the absence of wheezing or other signs of upper airway obstruction. Myxoedema coma is a differential diagnosis of respiratory acidosis. In myxoedematous coma, the possibility of difficult intubation due to supraglottic oedema should be considered. Tracheostomy should be considered for supraglottic myxoedema, which often results in prolonged ventilator use. Supraglottic myxoedema can be treated with oral medications.

Sudden Death Due to Undiagnosed Ludwig’s Angina: An Autopsy Case Report

Ludwig’s angina is a rapidly progressive and gangrenous cellulitis in the submandibular, sublingual spaces, and neck. It is characterized by an elevated tongue and laryngeal edema, resulting in airway compromise and, rarely, in sudden death. The most common cause is an odontogenic infection of a molar tooth. Infection can spread to the superior mediastinum and buccal area through anatomical structures. Herein, we report the sudden death of a 45-year-old male who was not diagnosed with Ludwig’s angina. He died in the emergency room 20 minutes after loss of consciousness. Intubation was impossible owing to severe laryngeal edema. The C-reactive protein level was 33.81 mg/dL. On autopsy, a diffuse light green abscess of the submandibular space was detected, along with severe edema of the epiglottis, aryepiglottic fold, and vocal cords. Subsequently, we confirmed that the airway obstruction was caused by Ludwig’s angina based on a literature review. In conclusion, this report emphasizes the need to identify the infection source and perform a detailed dissection according to the anatomical structure in the autopsy procedure for Ludwig’s angina.

OA24 Airway obstruction in an adolescent: relapsing polychondritis

OA24 Airway obstruction in an adolescent: relapsing polychondritis

Monitored Anesthesia Care for Conversion to Tracheostomy from Cricothyrotomy in a Patient with Severe Laryngeal Edema

Monitored Anesthesia Care for Conversion to Tracheostomy from Cricothyrotomy in a Patient with Severe Laryngeal Edema

Related Adverse Events after Immunotherapy in Patient with NK/T-Cell Lymphoma: a Case Report

A 29-year-old male with pathologically confirmed extranodal NK/T cell lymphoma of the tonsil, nasal type was admitted to Xinhua hospital affiliated to Shanghai Jiao Tong University School of Medicine. The patient was provided with several cycles of anti-PD-1 immunotherapy and obtained a Complete Response (CR) outcome. Despite the response, the patient also suffered from severe adverse effects, including a worsening pulmonary inflammation and severe laryngeal edema. A tracheotomy was performed to remove the white pseudo-membrane of laryngeal. via pathological analysis, necrosis of granuloma lymphoid cells and rhabdomous granuloma was found in this removed section. Meantime, a large amount of Candida nivaria, Klebsiella pneumoniae, and carbapenem-resistant Enterobacter was present in the patient’s sputum culture. The level of inflammatory cytokines (e.g., TNF-a, IL-1, IL-6, IL-17 and IFN-γ,) also increased significantly, indicating immune-related adverse events. Subsequently, the doctors adjusted immunotherapy to single-agent chemotherapy with additional anti-fungal and anti-bacterial infection treatment. The infection was well under control after these adjustments. 18F-FDG PET/ CT recorded the series of changes in the course of the patient from the start of immunotherapy.

ACUTE AIRWAY EDEMA AND RESPIRATORY FAILURE SECONDARY TO INVASIVE MUCORMYCOSIS

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Mucormycosis is known for its ability to manifest in human beings with varying presentations. Most notably this particular fungus has garnered its fierce reputation secondary to its devastating rhino-orbital-cerebral infections. The organisms responsible are abundant and easily culturable, commonly found in large numbers as the species is able to rapidly divide and spread its spores airborne. Unfortunately, there are scenarios that lead to predisposition of invasive disease including, diabetes mellitus in the setting of DKA, hematologic malignancies, AIDS, and solid organ transplant (1). A review of 208 cases published in between 1970 and 1993 quantified the frequency of initial symptoms. Fever, nasal ulceration with necrosis, and facial swelling accounted for the most common manifestations (2). CASE PRESENTATION: A 45-year-old male recently treated with induction chemotherapy and FLAG-IDA for AML developed subsequent pancytopenia and neutropenia. The Medical ICU team was called for an urgent evaluation after the patient developed acute onset left sided facial swelling, increased upper airway secretions, and voice change. Examination of his oropharynx revealed a black eschar on the hard pallet. A bedside NPL was urgently performed by ENT which revealed severe airway edema concerning for impending respiratory failure. The patient was subsequently intubated in the OR fiber optically, initial cultures and sample of the eschar were taken. The patient was empirically started on Amphotericin B liposome and remained intubated and sedated. The patient was taken to the OR urgently the next day for complete debridement of the hard palate, left maxillary sinus, and nasal turbinate. Surgical pathology confirmed the underlying suspicion for invasive Mucormycosis and culture later also grew out Rhizopus species. The patient was managed in the medical ICU with help of the infectious disease team for management of antifungal therapy. He was continued on Amphotericin B liposome throughout with the addition of Isavuconazole and Posaconazole. Unfortunately, the patient progressively deteriorated, developed septic shock and was transitioned to comfort measures by his family and expired shortly thereafter. DISCUSSION: Severe laryngeal edema causing acute respiratory failure has not been well documented. The overall mortality of Rhino-orbital-cerbral mucormycosis can be as high as 65%, thus prompt identification in the right clinical setting can be lifesaving (3). Management of the disease is based upon the cornerstone of urgent surgical debridement and immediate initiation of Amphotericin B lipid formulation. Salvage therapy can be attempted with Isavuconazole and also Posaconazole. CONCLUSIONS: We presented this case as a teaching point and also to raise awareness that acute onset airway edema in an immunocompromised patient can be the only presenting symptom of invasive Mucormycosis. Reference #1: Zygomycosis: an emerging fungal infection with new options for management. AUKauffman CA, Malani AN SO Curr Infect Dis Rep. 2007;9(6):435. Reference #2: Survival factors in rhino-orbital-cerebral mucormycosis.. AU Yohai RA, Bullock JD, Aziz AA, Markert RJ SO Surv Ophthalmol. 1994;39(1):3. Reference #3: Maureen M. Roden, Theoklis E. Zaoutis, Wendy L. Buchanan, Tena A. Knudsen, Tatyana A. Sarkisova, Robert L. Schaufele, Michael Sein, Tin Sein, Christine C. Chiou, Jaclyn H. Chu, Dimitrios P. Kontoyiannis, Thomas J. Walsh; Epidemiology and Outcome of Zygomycosis: A Review of 929 Reported Cases, Clinical Infectious Diseases, Volume 41, Issue 5, 1 September 2005, Pages 634–653 DISCLOSURES: No relevant relationships by Ediri Brume, source=Web Response No relevant relationships by Andrew Chu, source=Web Response No relevant relationships by Gustavo de la Roza, source=Web Response No relevant relationships by Bishal Gyawali, source=Web Response No relevant relationships by Dragos Manta, source=Web Response No relevant relationships by Ronald Russo, source=Web Response no disclosure on file for Dana Savici; No relevant relationships by Michael Williams, source=Web Response

Anesthetic Techniques and Complications for Airway Foreign Body Removal in Children

Theoretical basis: Aspiration of foreign bodies by children is a common problem around the world. Asphyxiation from inhaled foreign bodies is a leading cause of accidental death among children younger than 4 years. The Aim of the study is to determine different anesthetic techniques and complications for airway foreign body removal in children. Results: Most patients with aspirated foreign bodies are children younger than 3 years. Most of the aspirated foreign bodies are organic materials. Nuts (especially peanuts) and seeds (mainly sunflower and watermelon) are the most commonly aspirated foreign bodies reported in almost all studies. A history of a witnessed choking event is highly suggestive of an acute aspiration. Major iatrogenic complications were specified in 21 studies with 9437 children with aspirated foreign bodies. These complications included severe laryngeal edema or bronchospasm, pneumothorax, pneumomediastinum, cardiac arrest, tracheal or bronchial laceration, and hypoxic brain damage. Mortality data were obtained from 26 articles with 43 deaths among 10,236 children (0.42%) with aspirated foreign bodies. Anesthetic considerations encompass preoperative assessment, management techniques for flexible or rigid bronchoscopy, and postbronchoscopic disposition. Conclusion: Aspiration of a foreign body is a potentially lethal event. Although several anesthetic techniques are effective for managing children with foreign body aspiration, there is no consensus from the literature as to which technique is optimal.

Use of erbium laser in the treatment of persistent post-radiotherapy laryngeal edema: a case report and review of the literature

BackgroundPost-radiotherapy laryngeal edema may affect the patients’ quality of life, leading to repeated treatment attempts, which include massage/physical therapy, inhalations, and/or tracheostomy.Case presentationWe report the surgical treatment approach of a 69-year-old patient with severe persistent post-radiotherapy laryngeal edema. After multiple inpatient admissions and failed conservative therapy, we used the erbium laser to treat the arytenoid edema. After repeated procedures, no complications were observed. The patient remained free of symptoms after 30 months of follow-up.ConclusionsThe authors provide an easy-to-perform, safe, and quick surgical technique without non-severe or severe complications. Using this technique repeatedly, complications from excessive thermal damage with CO2 laser or unpleasant solutions such as tracheostomy can be avoided.

Relapsing Polychondritis Initially Presenting with Hoarseness and Difficulty Breathing in a 21-Year-Old Male

Objective: To present a case of relapsing polychondritis initially presenting with hoarseness and difficulty breathing and to discuss the diagnostic criteria and typical CT scan findings of relapsing polychondritis.
 Design: Case Report
 Setting: Tertiary Private Hospital in Metro Manila
 Case Report: A 21-year-old man who was initially managed as a case of bronchial asthma for persistent hoarseness and recurrent difficulty breathing was found to have severe laryngeal edema on endoscopy, and soft tissue expansion of the cricoid cartilage with calcifications and irregular first tracheal ring on CT scan. He also had recurrent eye redness and developed bilateral aural inflammation, and was subsequently diagnosed to have relapsing polychondritis.
 Conclusion: Relapsing polychondritis is a rare autoimmune disease characterized by recurrent inflammation and eventual destruction of cartilage throughout the body. Typical manifestations may not always be present, causing a delay in diagnosis. It should be considered in patients with intractable respiratory symptoms not responsive to treatment for upper respiratory tract infections or asthma. A CT scan may reveal signs of cartilage destruction and help in diagnosis. 
 Keywords: Polychondritis, Relapsing; airway involvement; imaging

Suspect anaphylaxis following intravenous buprenorphine administration in a dog

A seven-month-old French Mastiff was scheduled to undergo exploratory laparotomy for the removal of gastric foreign bodies. Buprenorphine 20 μg/kg was administered intravenously as preanaesthetic medication. Five minutes after the...

Impact of robot-assisted laparoscopic prostatectomy on the management of general anesthesia: efficacy of blood withdrawal during a steep Trendelenburg position.

Robot-assisted laparoscopic prostatectomy (RALP) is being increasingly used. However, a steep Trendelenburg position and pneumoperitoneum during RALP has an impact on the respiratory, cardiovascular and cerebrovascular systems. To prevent complications, restrictive fluid management and blood withdrawal have been utilized in our hospital. We examined differences in the anesthetic management between RALP and radical retropubic prostatectomy (RRP), and the efficacy of blood withdrawal. Medical records of patients who underwent radical prostatectomy in our hospital between January 2012 and October 2013 were retrospectively reviewed. Demographic data, intraoperative blood and fluid administration, perioperative complications and the length of hospital stay were compared among patients receiving RRP, and those receiving RALP with and without blood withdrawal (n = 78, 46 and 68, respectively). Patients receiving RALP with and without blood withdrawal received a smaller volume of crystalloid during surgery than those receiving RRP (mean ± SD, 5.8 ± 2.3 and 4.2 ± 1.6 vs 14.3 ± 4.1 ml/kg/h, p < 0.001). Median estimated blood loss was 885 g (80-2,800 g) for RRP and 50 g for RALP (3-950 g and 3-550 g, respectively), p < 0.001. None of the patients undergoing RALP received red blood cells, but three patients undergoing RRP did so. RALP with blood withdrawal reduced postoperative hospital stay by 45 % (6 vs 11 days). Four patients receiving RALP without blood withdrawal had delayed extubation due to severe laryngeal edema, which did not occur in any of the patients receiving RALP who had blood withdrawal. Renal function did not differ among the groups. RALP was associated with less blood loss, no allogeneic transfusion and shorter postoperative hospital stay. This study indicated that blood withdrawal could prevent severe laryngeal edema.

Pathological changes of the three clinical types of laryngeal burns based on a canine model

ObjectiveThe study was designed to examine pathological changes of inhalational laryngeal burns of three clinical types: congestive, oedematous and obstructive. MethodsA total of 18 healthy, male, adult Beagle dogs were randomly assigned to inhale hot dry air at room temperature (group C), 80°C (Group 1), 160°C (Group 2) or 320°C (Group 3) for 20min to induce inhalation injury. Each larynx was evaluated and scored based on the ‘clinical scoring and typing system of laryngeal burns at early stage’. Tissue samples of the epiglottis, laryngeal vestibule, vocal folds and infraglottic cavity of the larynx were observed microscopically and evaluated based on a ‘pathological scoring system’. ResultsPathological changes of the larynxes of groups 1 and 2 were primarily characterised by slight atrophy of the mucosa and mild oedema of the submucosal tissues. Group 3 larynxes showed two distinct pathological changes: oedematous and atrophic types. The larynxes of the atrophic type showed lower clinical scores (29.5±0.7 vs. 44.3±2.1) but higher pathological scores (18.6±3.2 vs. 13.7±1.8) than the larynxes of the oedematous type. ConclusionSevere laryngeal burns could manifest as severe laryngeal oedema or atrophic change. The laryngeal burns of the atrophic type might suggest an unsatisfactory prognosis, although it had less risk of laryngeal obstruction at an early stage.

Endoscopic mucosal resection and endoscopic submucosal dissection for en bloc resection of superficial pharyngeal carcinomas

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are being used increasingly to treat superficial oropharyngeal and hypopharyngeal carcinomas. The aim of this study was to clarify whether ESD provided better results than EMR for en bloc and complete resection of superficial pharyngeal carcinomas. A total of 76 superficial pharyngeal carcinomas in 59 consecutively treated patients were included. Patients underwent either conventional EMR (using a transparent cap or strip biopsy) (n = 45 lesions) or ESD (n = 31 lesions) between October 2006 and January 2011. The rates of en bloc resection, complete resection (defined as en bloc resection with tumor-free margins), major complications, and local recurrence were evaluated retrospectively as the therapeutic outcomes. ESD yielded significantly higher rates of both en bloc and complete resection compared with EMR (en bloc 77.4 % [24/31] vs. 37.8 % [17/45], P = 0.0002; complete 54.8 % [17/31] vs. 28.9 % [13/45], P = 0.0379). ESD was more frequently complicated by severe laryngeal edema (4/21 [19.0 %] vs. 1/31 [3.2 %], P = 0.1446) and was also more time-consuming (124.9 ± 65.1 minutes vs. 57.2 ± 69.6 minutes; P = 0.0014). Local recurrence was observed more often after EMR than after ESD (3/45 [6.7 %] vs. 0/31 [0 %]), although this difference did not reach statistical significance (P = 0.2658). ESD appears to be a superior method of endoscopic resection of superficial pharyngeal carcinomas for achieving both en bloc and complete resection, although these benefits were also associated with a higher incidence of complications and a significantly longer procedure time. Large prospective studies are needed to compare ESD with conventional EMR for superficial pharyngeal carcinomas.

Successful hyperbaric oxygen therapy for laryngeal radionecrosis after chemoradiotherapy for mesopharyngeal cancer: case report and literature review

Laryngeal radionecrosis is one of the most troublesome late complications of radiotherapy, because it is frequently resistant to treatment and laryngectomy is required in the worst case. Here, we report a case of laryngeal radionecrosis, successfully treated by use of hyperbaric oxygen (HBO) therapy, in which laryngectomy was avoided. A 67-year-old male received radical chemoradiotherapy (CRT) for mesopharyngeal cancer, which included radiotherapy with a total dose of 71.4 Gy/38 Fr and chemotherapy with CDDP + S-1. He developed dyspnea and throat pain 9 months after completion of CRT. Laryngoscopy revealed vocal cord impairment because of severe laryngeal edema. He was diagnosed as having laryngeal radionecrosis and initially received conservative therapy combined with antibiotics, steroids, and prostaglandins. Because his dyspnea was persistent despite this treatment, HBO therapy was administered 20 times, and resulted in complete remission of the dyspnea. HBO therapy, therefore, is regarded as an effective conservative therapeutic option for laryngeal radionecrosis.

Clinical, Histological, and Genetic Features of Fourth Ventricle Ependymoma in the Elderly

A 71-year-old woman presented with a rare case of geriatric ependymoma originating from the fourth ventricle manifesting as progressive gait and memory disturbance. Imaging studies revealed an extraaxial mass in the fourth ventricle protruding into the right cerebellomedullary cistern, with concomitant obstructive hydrocephalus. Surgery achieved subtotal removal since the tumor tightly adhered to the right vestibular area of the fourth ventricular floor. The histological diagnosis was ependymoma, which was also confirmed by comparative genetic hybridization. Although she developed severe laryngeal edema and worsening of the hydrocephalus postoperatively which required additional treatment, she recovered with residual mild gait disturbance, and was transferred to a rehabilitation facility. Fourth ventricle ependymoma in the elderly is rare. Comparative genetic hybridization may be important in the diagnosis of geriatric ependymoma and in the choice for adjuvant therapy as well as in estimating the prognosis for patients with rare types of ependymoma.

Evaluation of CO2 Laser Surgery for Early Carcinoma Larynx

ABSTRACTObjectiveTo evaluate the effectiveness of transoral endoscopic laser surgery in the treatment of early laryngeal cancers in comparison to external radiotherapy.Method: The patients included in the study were those who reported to the ENT department of a tertiary care hospital with early malignant lesions of the larynx.ResultOur study revealed a local recurrence rate of 15% in the radiotherapy arm but only 10% in the CO2laser arm; however, this difference was not statistically significant. The only parameter in the analysis of voice which showed a statistically significant difference between the two arms was roughness which was better in the radiotherapy arm at 6 months. The major complication following transoral CO2laser surgery was persistent hoarseness which was seen in six patients and it resolved completely on continuation of conservative measures. Severe laryngeal edema following treatment was seen in two patients. Statistically significant difference was noted in patient acceptability in favor of CO2laser.ConclusionEndoscopic CO2laser surgery in early laryngeal cancer leads to similar control of the disease as with the traditional methods, with better patient acceptability, low morbidity and good functional results.