Anesth Analg 2007;105:551-552
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000265697.58845.fd
LETTER TO THE EDITOR
Section Editor:
Lawrence Saidman
Extensive Endobronchial Calcification Contributing to Hypoxia in a Quadriplegic Patient
Roberto Imberti, MD,
Paolo Pricca, MD,
Luigi Pietrobono, MD, and
Martin Langer, MD
2nd Department of Anesthesiology and Critical Care Medicine; Fondazione IRCCS Policlinico S. Matteo; Pavia, Italy; r.imberti{at}smatteo.pv.it (Imberti)
Department of Radiology; Fondazione IRCCS Policlinico S. Matteo; Pavia, Italy (Pricca, Pietrobono)
Department of Anesthesiology and Critical Care Medicine; Fondazione IRCCS Istituto Nazionale dei Tumori; Milano, Italy (Langer)
To the Editor:
We report a rare case of a quadriplegic patient in whom the entire bronchial tree of the lower right lobe was completely occluded by calcium deposit.
A 30-yr-old patient presented with hyperthermia, dyspnea, and severe hypoxia. He had been quadriplegic following spinal trauma to C4–6 nine years previously, experienced recurrent pulmonary infections and episodes of hemoptysis, and still needed a tracheostomy to remove bronchial secretions. Mechanical ventilation and antibiotics were started (levofloxacin at first empirically, later substituted for with linezolid after isolation of methicillin-resistant Staphylococcus aureus). Thoracic CT scan showed widespread consolidation in the lower right lobe (Fig. 1), and an extensive, occlusive calcification of the bronchial tree (Figs. 1 and 2), whereas arterial perfusion of the lobe was maintained (Fig. 2), resulting in severe but localized perfusion/ventilation mismatch contributing to hypoxia. In fact, despite resolution of pneumonia, gas exchanges were severely impaired (Pao2/Fio2 150). Resection of the right lower lobe resulted in an improvement of oxygenation (Pao2/Fio2 250–310) and separation from the ventilator. Three years later the patient is still breathing autonomously in a stable general condition.
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Figure 1. High resolution CT scan showing widespread consolidation and extensive calcification of the bronchial tree in the lower right lobe.
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Figure 2. CT scan showing occlusive calcification in the lower right lobe. Arterial perfusion is maintained.
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Recurrent infections, trauma, and hemorrhages of the right bronchial tree during frequent daily suctions could have led to calcium deposition. Bone resorption, a common sequel of spinal cord injury (1), could have contributed to the pathologic process.
REFERENCE
- Roberts D, Lee W, Cuneo RC, Wittmann J, Ward G, Flatman R, McWhinney B, Hickman PE. Longitudinal study of bone turnover after acute spinal cord injury. J Clin Endocrinol Metab 1998;83:415–22[Abstract/Free Full Text]
