IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES Concrete Airway Seung Yong Park1, Heung Bum Lee1, Min Ho Kim2, Ja Hong Kuh2, Jong Bum Choi2, Yong Chul Lee1, and Kyung Hwa Kim2 1 Department of Internal Medicine and 2Department of Thoracic and Cardiovascular Surgery, Research Institute of Clinical Medicine, Chonbuk National University Medical School, Jeonju, Republic of Korea

Figure 1. The chest X-ray showed impaction of radiopaque materials (arrows) in the trachea and bronchi.

A 58-year-old man presented with dyspnea after he was buried by ready-mixed concrete. The chest X-ray showed impaction of radiopaque materials in the trachea and bronchi (Figure 1). These radiopaque substances induced near-total obstruction of the central airway in the computed tomography of the chest (Figure 2). Emergent fiber-optic bronchoscopy was performed via endotracheal tube and revealed a combined material composed of cement, gravel, and sand obstructing the trachea (Figure 3). To secure the ventilation, we next performed rigid bronchoscopy. He took a sudden turn for the worse during the extraction of the mixed concrete from the trachea. Arterial blood gas characterized acute respiratory failure (pH 6.94, PCO2 141 mm Hg, and PO2 55 mm Hg). Venovenous extracorporeal membrane oxygenation (ECMO) was started for proper ventilation and facilitative intervention. He was stabilized under the ECMO, and then repeated rigid and fiber-optic bronchoscopy were done safely.

Am J Respir Crit Care Med Vol 189, Iss 1, pp e1–e3, Jan 1, 2014 Copyright © 2014 by the American Thoracic Society DOI: 10.1164/rccm.201303-0435IM Internet address: www.atsjournals.org

Images in Pulmonary, Critical Care, Sleep Medicine and the Sciences

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IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES

Figure 2. The computed tomography of the chest demonstrated that the radiopaque substances induced near-total obstruction of the central airway.

Figure 3. Fiberoptic bronchoscopy revealed a combined material composed of cement, gravel, and sand obstructing the trachea.

Figure 4. Follow-up computed tomography (A) showed the disappearance of mixed concrete materials, and the bronchoscopy (B) demonstrated no airway obstruction and stenosis.

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American Journal of Respiratory and Critical Care Medicine Volume 189 Number 1 | January 2014

IMAGES IN PULMONARY, CRITICAL CARE, SLEEP MEDICINE AND THE SCIENCES The application of ECMO to cases of central airway obstruction has been limited. As a rescue maneuver, emergency bedside venovenous ECMO can provide a proper gas exchange to a patient with life-threatening airway obstruction. In addition, it can provide a chance to remove the obstructing materials safely (1). The patient was weaned from ECMO 3 days later and discharged 3 weeks later (Figure 4) after a whole-lung lavage. n Author disclosures are available with the text of this article at www.atsjournals.org.

Reference 1. Willms DC, Mendez R, Norman V, Chammas JH. Emergency bedside extracorporeal membrane oxygenation for rescue of acute tracheal obstruction. Respir Care 2012;57:646–649.

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