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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 4  |  Issue : 1  |  Page : 65-66

Mucus plug masquerading as an intratracheal mass identified prior to incidental urologic surgery


1 Department of Anaesthesiology, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India
2 Department of Urology and Renal Transplantation, Dr Ram Manohar Lohia Hospital and Atal Bihari Vajpayee Institute of Medical Sciences, New Delhi, India

Date of Submission22-Dec-2020
Date of Acceptance10-Feb-2021
Date of Web Publication29-Apr-2021

Correspondence Address:
Dr. Uma Hariharan
BH-41, East Shalimar Bagh, Delhi - 110 088
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/arwy.arwy_66_20

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How to cite this article:
Hariharan U, Pandey A, Shivpriya PN, Goel HK. Mucus plug masquerading as an intratracheal mass identified prior to incidental urologic surgery. Airway 2021;4:65-6

How to cite this URL:
Hariharan U, Pandey A, Shivpriya PN, Goel HK. Mucus plug masquerading as an intratracheal mass identified prior to incidental urologic surgery. Airway [serial online] 2021 [cited 2021 Jun 20];4:65-6. Available from: https://www.arwy.org/text.asp?2021/4/1/65/315170



Tracheal tumours may cause intraluminal or extraluminal airway obstruction. During general anaesthesia and positive pressure ventilation, these may cause sudden unrelieved airway obstruction and life-threatening increase in intrathoracic pressure.[1] Mucus plugs in the airway are common in several congenital or acquired airway conditions.[2] These include bronchiectasis, cystic fibrosis, primary ciliary dyskinesia, muscular dystrophies and chronic smoking.[3] Large and thick mucus plugs can partially or completely obstruct the airway and can cause serious perioperative complications.[4] We present a unique case of a mucus plug in the airway of a bronchiectatic patient mimicking an intraluminal tracheal mass.

A 26-year-old male who presented with complaints of flank pain, burning micturition and shortness of breath since few weeks was posted for ureteroscopic lithotripsy for left ureteric calculus. Ultrasonography showed right small contracted kidney with loss of corticomedullary differentiation. The left kidney was hydronephrotic with well-maintained corticomedullary differentiation. Preanaesthetic evaluation was unremarkable except for deranged renal function test (serum creatinine 4.6 mg/dL, blood urea 124 mg/dL) and bronchiectatic changes in chest X-ray. The patient had a history of pulmonary tuberculosis a few years earlier followed by the development of bronchiectasis. High-resolution computed tomography of the chest confirmed bronchiectatic changes in the right upper lobe and an intraluminal polypoidal mass along the right tracheal wall. Opinion was sought from the cardiothoracic surgeon and chest physician. A decision was taken to perform bronchoscopy with bronchoalveolar lavage. Bronchoscopy revealed that there was no tracheal mass but a large mucus plug was present on the right tracheal wall. This mucus plug was thoroughly suctioned and the airway lumen was completely cleared of all secretions. Bronchoalveolar lavage fluid was sent for laboratory analysis.

After confirming that there was no tracheal growth and clearing of the mucus plug from the airway, the patient was taken up under antibiotic cover for ureteroscopic lithotripsy after chest physiotherapy and nebulisation. Combined spinal-epidural anaesthesia was given under all aseptic precautions with the patient in the sitting position. The perioperative course was uneventful with normal vital parameters while the patient was breathing spontaneously. Postoperatively, the patient was transferred to the Intensive Care Unit for monitoring and observation. The patient was later shifted to ward the next day and advised to follow-up with chest physician.

Our case exemplifies that a big mucus plug could masquerade as an intraluminal tracheal mass. Meticulous preoperative evaluation forms the cornerstone of successful patient outcome. Airway obstruction from an intratracheal growth can be life-threatening, especially under anaesthesia, as they can cause sudden airway obstruction and inability to ventilate.[5] Positive pressure ventilation in such conditions may cause increase in intrathoracic pressure leading on to a tension pneumothorax and shock.[1] This makes preoperative identification of an intraluminal tracheal mass important.

Declaration of patient consent

The authors certify that they have obtained the appropriate patient consent form. In the form, the patient has given his consent for clinical information to be reported in the journal. The patient understands that his name and initials will not be published, and due efforts will be made to conceal his identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hatipoglu Z, Turktan M, Avci A. The anesthesia of trachea and bronchus surgery. J Thorac Dis 2016;8:3442-51.  Back to cited text no. 1
    
2.
Panchabhai TS, Mukhopadhyay S, Sehgal S, Bandyopadhyay D, Erzurum SC, Mehta AC. Plugs of the air passages: A clinicopathologic review. Chest 2016;150:1141-57.  Back to cited text no. 2
    
3.
Tian PW, Wen FQ. Clinical significance of airway mucus hypersecretion in chronic obstructive pulmonary disease. J Transl Int Med 2015;3:89-92.  Back to cited text no. 3
    
4.
Bustamante-Marin XM, Ostrowski LE. Cilia and mucociliary clearance. Cold Spring Harb Perspect Biol 2017;9:a028241.  Back to cited text no. 4
    
5.
Wong P, Wong J, Mok MU. Anaesthetic management of acute airway obstruction. Singapore Med J 2016;57:110-7.  Back to cited text no. 5
    




 

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