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Tracheoesophageal Fistula with Tracheal Dilatation in a Patient with a Tracheostomy Using a Home Mechanical Ventilator

기관절개 상태로 가정에서 인공환기 중에 발생한 기관확장과 기관식도루

  • Kim, Byounghoon (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Joo, Min Sun (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Kim, Yoo Na (Department of Radiology, Hallym University Kangnam Sacred Heart Hospital) ;
  • Shin, Tae Rim (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea) ;
  • Park, Sang Myeon (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Kim, Dong Gyu (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital) ;
  • Sim, Yun Su (Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital)
  • 김병훈 (한림대학교 강남성심병원 호흡기 알레르기내과) ;
  • 주민선 (한림대학교 강남성심병원 호흡기 알레르기내과) ;
  • 김유나 (한림대학교 강남성심병원 영상의학과) ;
  • 신태림 (한림대학교 강남성심병원 호흡기 알레르기내과) ;
  • 박상면 (한림대학교 강남성심병원 호흡기 알레르기내과) ;
  • 김동규 (한림대학교 강남성심병원 호흡기 알레르기내과) ;
  • 심윤수 (한림대학교 강남성심병원 호흡기 알레르기내과)
  • Received : 2013.08.14
  • Accepted : 2013.10.23
  • Published : 2014.07.01

Abstract

Patients with tracheostomies requiring prolonged home mechanical ventilation are increasing in number rapidly. A tracheoesophageal fistula is a relatively unusual complication, but this case resulted in a fatal outcome. We describe a tracheoesophageal fistula with tracheal dilation in a 72-year-old female who had a prolonged tracheostomy and nasogastric tube, using a home mechanical ventilator. On enhanced CT images, the tracheostomy tube was well located within the trachea with no abnormal finding. However, chest enhanced CT images obtained 5 months later showed marked circumferential wall thickening of the trachea with tiny ulceration, a markedly increased diameter of the tracheal lumen, and a tracheoesophageal fistula. In patients using home mechanical ventilators, the location and cuff pressure of the tracheostomy tube and the nasogastric tube should be evaluated routinely.

이 증례는 만성 호흡부전으로 기관절개 상태로 가정에서 인공환기기 유지 중인 환자에서 기관벽 약화와 기관식도루를 진단한 경우이다. 의학의 발전으로 가정에서 인공환기기를 유지하는 환자가 늘고 있다. 이러한 환자에서 호흡곤란이 발생하였을 때 기저질환 악화나 폐렴 등의 발생 외에도 기관절개관의 합병증도 고려되어야 하며 평소에 가정에서 인공환기기의 사용법뿐만 아니라 기관절개관과 경비위관의 관리도 철저한 주의가 필요하겠다.

Keywords

References

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