Author + information
- Received October 23, 2012
- Accepted November 11, 2012
- Published online April 1, 2013.
- ↵⁎Reprint requests and correspondence:
Dr. Vishesh Kumar, Center for Systems Biology, Massachusetts General Hospital, Richard B. Simches Research Plaza, 185 Cambridge Street, Room 5.210, Boston, Massachusetts 02114
A 64-year-old woman with a history of coronary artery disease was admitted to the hospital after sudden onset of crushing chest pain. Electrocardiogram showed marked ST-segment elevation in inferior leads. Intravenous heparin and eptifibatide were started, and cardiac catheterization was performed with stenting of her occluded right coronary artery. During the procedure she developed cardiogenic shock requiring intra-aortic balloon pump placement. To protect her airway, endotracheal intubation was performed. Soon after intubation, she developed worsening hypoxia; and during manual ventilation, a significant amount of resistance was met. Upon suctioning, frank bloody secretions were returned from the endotracheal tube. Emergent tracheostomy and rigid bronchoscopy were performed, with retrieval of a large blood clot cast of the tracheobronchial tree measuring 13 × 4 cm (Fig. 1). Direct laryngoscopy showed actively bleeding pharyngeal tear, which was successfully cauterized. She rapidly stabilized and was sent to the intensive care unit for observation and, a few days later, was discharged to a rehabilitation facility. Histological examination of the cast showed fragments of fibrinous blood clot mixed with benign bronchial epithelial cells. The cause of the pharyngeal tear resulting in bleeding was probable trauma during endotracheal intubation in the setting of anticoagulation.
Only very few case reports have reported this complication in the past (1–3). Interventionalists should keep this rare complication in mind while managing a patient who develops sudden respiratory failure on anticoagulation after a mechanical airway intervention.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 23, 2012.
- Accepted November 11, 2012.
- American College of Cardiology Foundation