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J Thorac Cardiovasc Surg 2003;126:867-869
© 2003 The American Association for Thoracic Surgery
Brief communications |
a Department of Thoracic and Vascular Surgery, Heidehaus Hospital, Hannover Medical School, Hannover, Germany
Received for publication June 10, 2002; revisions received July 8, 2002; revisions received July 10, 2002; accepted for publication July 18, 2002.
* Address for reprints: Paolo Macchiarini, MD, PhD, Department of Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), Am Leineufer 70, 30419, Hannover, Germany
pmacchiarini@compuserve.com
| The first 300 words of the full text of this article appear below. |
Individuals with long-lasting ankylosing spondylitis (AS, Bechterew disease) are at increased risk for developing fractures as the fused spine often becomes osteoporotic. These bony protuberances may compress all elements lying in front of them and induce a soft-tissue inflammation to the extent that it causes irreversible dysphagia, especially at the level of the cervical spine.1 We describe here the decompression of the entire visceral mass of the median thoracic aperture by a simple manubriectomy in an AS patient with refractory dyspnea and dysphagia.
Clinical summary
A 62-year-old man with a 15-year history of AS was referred to our department for treatment of severe dyspnea and solid dysphagia of unknown cause. His medical history was significant for chronic alcohol abuse. Recently, he developed solid dysphagia and became increasingly dyspneic to the extent that he had his first episode of asphyxia, requiring an emergency nasotracheal intubation and mechanical ventilation. Initial fibroscopy revealed a massive laryngeal edema and a suboccluded subglottic region; plain cervical radiology was negative and computed tomography (CT) showed a massive prevertebral soft-tissue swelling. Following the acute episode, the patient was weaned and an extubation was attempted twice over a period of 1 month. Both attempts failed because of the persistence of the cervical soft-tissue swelling despite aggressive anti-inflammatory and steroid therapy. Because of that, a nasotracheal tube was used; the tip was placed below the edematous upper airway and the patient was weaned and allowed to breathe spontaneously. He was referred to us 2 weeks thereafter with the intent to perform a definitive mediastinal tracheostomy.
Examination revealed a global restriction of spinal movements in keeping with long-standing AS without neurological deficits (with the exception of motor disturbance of his right fingers). Of note was that the chin to manubrium sterni angle was less than 20°. Close questioning revealed only that following
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