Tracheostomy tube introducer dislodged in trachea misdiagnosed as a mucus plug: a case report (ID 480)
liverpool Heart and Chest Hospital
Funding: None
Abstract
Introduction:Although tracheostomy tube insertion can be a life-saving procedure; It can also present with its own complications. In this study, we present a case of long-term complications of tracheostomy tube insertion.
Case presentation:
A 59-year-old male presenting with recurrent cough and chest infections. The patient developed SAH in July 2020 where he required long ITU admission period. Patient had to be intubated, later had a tracheostomy tube and NG tube inserted. He was then discharged in September 2020 to a rehab unit. At that point patient had right sided weakness, expressive dysphagia and needed a transfer hoist but was able to have normal diet, decannulated and didn’t need oxygen on discharge.
Later on, patient was admitted to hospital with enterococcus faecalis septicaemia and recurrent cough in March 2021. CT scan showed mild mucous secretions in the trachea extending into right main and lower lobe bronchus and collapsed consolidation in the right lower lobe grossly unchanged. Patient still suffered from recurrent cough that worsened especially at night. Repeat CT done in December 2021 showed stable appearance of trachea, right middle and lower lobe bronchi with associated partial collapse of the right lobe, probably secondary to mucus plugging. In view of ongoing cough, patient underwent bronchoscopy which identified a white fine tube-like foreign body in trachea and reaching right lower lobe bronchus. Approximately 16 cm long tube, part of the tracheostomy introducer was retrieved under General Anaesthesia using rigid bronchoscopy and patient felt immediate relief.
Conclusion:
Complications of tracheostomy can happen long after the period of insertion and present with mild respiratory symptoms rather than acute airway obstruction, which is usually more alarming; therefore, a high index of suspicion is required in patients with a history of tracheostomy presenting with ongoing respiratory symptoms.
Conflicts of interest: None
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