Cesarean section in a patient with threatening hemoptysis caused by tracheal carcinoid

A woman 29 weeks pregnant presented with acute respiratory insufficiency and massive hemoptysis of unknown origin. An emergency cesarean section was performed to avoid hypoxic fetal damage during episodes of maternal hypoxemia. Bleeding was due to an unsuspected endotracheal carcinoid tumor located near the carina. The tumor obstructed the distal portion of the trachea, leading to life-threatening complications during tracheal intubation because of its histological characteristics and placement. Pulse oximetry response to standard mechanical ventilation was unsatisfactory. Special measures to ventilate mother and fetus were successful, in spite of iatrogenic pneumothorax and pneumomediastinum. We report an exceptional case of tracheal carcinoid tumor during the pregnancy and recommend that tracheal or bronchial intubation take place under fiber optic guidance in cases of hemoptysis with no firm etiologic diagnosis.     

Management of massive air leak following intubation injury in a very low birth weight infant

Perforation of an infant’s trachea after orotracheal intubationfor general anaesthesia is a rarely described serious complication.This article reports an unusual case of laceration of the tracheain an 8-week-old infant with a history of prolonged neonatalintubation needed to treat hyaline membrane disease. After diagnosisthe tracheal injury was managed conservatively. Factors involvedin the occurrence of the injury and its management are discussed. Br J Anaesth 2002; 88: 722–3