Barr Lori,  Coticchia James

Final Pr. ID: Poster #: CR-022

Exudative tracheitis is the most common life-threatening acute airway abnormality in children and is usually associated with infections. Post-extubation obstructive fibrinous tracheal pseudomembrane is a rare early complication following intubation with less than 53 reports in the literature, the majority in adults.
A 12-year-old was intubated in the field when found unresponsive. The patient was transferred to the pediatric Intensive care unit where a drug overdose was diagnosed and the patient was soon extubated. Five days later, the patient experienced acute respiratory distress. Soft tissue neck radiographs demonstrated nodularity and narrowing of the subglottic portion of the trachea. A subsequent neck CT and MRI also demonstrated subglottic/tracheal irregularity and a cylindrical filling defect. The intraluminal membrane was removed via bronchoscopy with subsequent tracheal debridement. Pathologic examination revealed a fibrinous pseudomembrane.
The imaging appearance of exudative tracheitis is not specific and can be seen with infectious tracheitis, necrotizing tracheitis, and, as in this case, obstructive fibrinous tracheal pseudomembrane. Obstructive fibrinous tracheal pseudomembrane occurs following tracheal intubation with cuffed or cuffless tubes, tracheostomy tubes, and after tracheal stenting. It has also been reported in patients with gastroesophageal reflux disease. It usually presents in the early days following extubation in cases associated with endotracheal tubes. It is thought to be a very early post-traumatic response and precursor to tracheal stenosis. Since patients are often weak following recent illnesses requiring airway intervention, their symptoms may be minimal until the airway is critical and the condition is life-threatening. This is a surgical emergency. Diagnostic confirmation by flexible bronchoscopy is followed by treatment with rigid bronchoscopy. This should not be delayed by the performance of imaging studies. If diagnostic imaging is performed, the findings of airway wall irregularity and subglottic or deeper intraluminal soft tissue density material, especially if the shape mimics the endotracheal device (cylindrical), are diagnostic of exudative tracheitis including infectious, iatrogenic and reflux-related post-traumatic causes. A high index of suspicion on the part of the radiologist has the potential to decrease time-to-treatment and thus decrease complications such as tracheal stenosis and death. Read More

Authors:  Barr Lori , Coticchia James

Keywords:  pseudomembranous, tracheitis, computed tomography