Anesth Analg 2004;99:1576-1577
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000137443.81088.4B
LETTERS TO THE EDITOR
Incidental Radiologic Discovery of a Large Posterior Pharyngeal Mass in a Tracheally Intubated Child With Facial Anomalies
Jeffrey J. Pasternak, MD,
Susan L. Ryan, CRNA, and
William L. Lanier, MD
Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, MN, pasternak.jeffrey@mayo.edu
To the Editor:
A 6 year-old female patient with facial anomalies was scheduled for magnetic resonance imaging (MRI) during general anesthesia. The trachea was intubated with difficulty due to an anterior-displaced larynx. During initial controlled ventilation, there was a gas leak around the endotracheal tube at 12 cm H2O continuous pressure. When the leak worsened mid-MRI (now occurring at 6 cm H2O) and interfered with ongoing mechanical ventilation, we elected to treat the leak by placing a water-soaked gauze pack within the pharynx, instead of replacing the tube. Later, the radiologist informed us that he had incidentally discovered a large pharyngeal mass (Fig. 1). When we suggested that the "mass" was gauze packing, the radiologists expressed reservation because the water content of the mass was consistent with that of human tissue.
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Figure 1. Magnetic resonance image of the pharynx, demonstrating a large "mass," related to the placement of a water-soaked gauze sponge to lessen an airway leak.
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To resolve this issue, we allowed the patient to resume breathing (so that adequate ventilation could be maintained) and removed the water-soaked gauze. Additional MRI scanning revealed a normal-appearing pharynx (Fig. 2).
Incidental findings on MRI are common, occurring in 18% of brain scans in one study (1). Most require no further workup. In our patient, the origin of an iatrogenic mass was confirmed by collaboration between radiology and anesthesiology personnel.
Reference
- Katzman GL, Dagher AP, Patronas NJ. Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers. JAMA 1999; 282: 36–9.[Abstract/Free Full Text]
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