Over-Inflating a Tracheostomy Tube Cuff for Tracheo-Innominate Artery Fistula

Yi-Chia Hsieh; Wen-Ruei Tang; Ying-Yuan Chen

doi:10.3390/diagnostics14020223

,

and

¹

Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan

²

Division of Thoracic Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704302, Taiwan

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

Diagnostics2024, 14(2), 223;https://doi.org/10.3390/diagnostics14020223

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Abstract

We report an angiographic image of a 58-year-old woman with profuse bleeding from a tracheo-innominate artery fistula. It may not have been possible to obtain this valuable image if adequate initial resuscitation and an over-inflated tracheostomy tube cuff had not been administered to stop bleeding during an emergency.

Keywords:

tracheo-innominate artery fistula; complication of tracheostomy; computed tomography angiography

A 58-year-old woman presented to our hospital with profuse bleeding from a deflated cuff tracheal stoma. She had stage IVB anaplastic thyroid carcinoma with upper airway obstruction and had undergone tracheostomy 3 months prior to this admission. Pembrolizumab 100 mg (2 mg/kg) had been given every 3 weeks and she had received a radiation dose of 75 Gy in 25 fractions over the neck tumor. The cuff of a tracheostomy tube was over-inflated to temporarily stop bleeding in an emergency. In suspicion of a tracheo-innominate artery fistula, she received computed tomography angiography after initial stabilization (Figure 1 and Figure 2).

Figure 1. Computed tomography angiography of a 58-year-old woman with excruciating tracheostoma bleeding temporarily controlled by over-inflating her tracheostomy. (A) Sagittal view, (B) coronal view, (C) axial view. The images revealed contrast extravasation at innominate artery middle part (pointed by bordered box arrows) that was directly tamponaded by over-inflated tracheostomy tube cuff (demonstrated by bulging tracheal wall and circled by arrowheads).

Figure 2. Fistula identification using angiography of the patient with a slightly deflated tracheostomy tube cuff. Flow of contrast into upper trachea through fistula (white star) at tracheostomy tube cuff (circled by arrowheads); right innominate artery (arrow). The patient was managed with endovascular stenting followed by ligation of innominate artery in a hybrid operation theater (Figure S1). Two weeks later, she was discharged to a chronic care center. The patient died peacefully at the chronic care center two weeks after discharge due to terminal disease.

Besides adequate initial resuscitation, over-inflating the cuff of a tracheostomy tube may be an effective technique to temporarily control bleeding from tracheo-innominate artery fistulae [,,,,]. This case demonstrated the reliability of computed tomography angiography as an imaging modality for confirmation.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/diagnostics14020223/s1, Figure S1: Angiography and intraoperative picture of surgical procedure.

Author Contributions

Conceptualization, W.-R.T. and Y.-Y.C.; investigation, Y.-C.H. and W.-R.T.; writing—original draft preparation, Y.-C.H. and W.-R.T.; writing—review and editing, Y.-Y.C.; visualization, W.-R.T.; supervision, Y.-Y.C. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and was approved by National Cheng Kung University Hospital Institutional Review Board on 2023.12.20 (IRB No. B-EC-112-034; Date: 2023.12.20).

Informed Consent Statement

Written informed consent for the publication of details and images was obtained from the patient’s husband.

Conflicts of Interest

The authors declare no conflicts of interest.

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