case_images: PMC11802439_01
case_images: Bronchoscopy condition as of July 1, 2022. (A) No obvious abnormality were noted in the main airway below the tracheostomy sleeve. (B) Severe edema noted in throat and glottic region. (C) A view of severe glottal edema with support laryngoscope. (D) A Suprastomall granuloma obstructs the airway. (E) The majority of the granulomas were removed using the bronchoscope snare device allowing partial opening of the upper airway. (F) Montgomery T tube was inserted.
case_images: fmed-12-1457903-g001.jpg
case_images: PMC11802439_01_fmed-12-1457903-g001.jpg
case_images: fig1
case_images: This examination revealed no observable abnormalities at the lower end of the tube and in the distal extent of airway (Figure 1A). It was found that severe edema and local tissue disfiguration in the pre-tracheal pharyngeal region (Figure 1B) did not permit, after several attempts, positive identification of the tracheal opening. During the procedure, we requested that otolaryngologist use the laryngoscope observe the tissue of swollen glottic area (Figure 1C), expose the upper airway of the Tracheotomy incision. More granulomas were found in the upper airway which blocked almost the entire airway (Figure 1D). The granulomas were first removed using a fiberoptic bronchoscopic snare device (Figure 1E).
case_images: Bronchoscopy condition as of July 13, 2022. (A) Glottic edema was reduced, but was still obvious. (B) Montgomery T tube in optimal position. (C) No new granuloma appeared in the main part of the airway below Montgomery T tube.
case_images: fmed-12-1457903-g002.jpg
case_images: PMC11802439_01_fmed-12-1457903-g002.jpg
case_images: fig2
case_images: Microscopically we saw a partially diminished edematous condition of the glottis and surrounding tissues (Figure 2A), a well-positioned Montgomery T tube (Figure 2B), and no new granulomas in the airway (Figure 2C).
case_images: Bronchoscopy condition as of September 19, 2022. (A) No new granulomas noted in the airway below Montgomery T tube. (B) Glottic edema has notably subsided, but is not completely normal at this point. (C) Remove Montgomery T tube using biopsy forceps. (D) After removal of Montgomery T tube, the airway was essentially smooth.
case_images: fmed-12-1457903-g003.jpg
case_images: PMC11802439_01_fmed-12-1457903-g003.jpg
case_images: fig3
case_images: At this time, some edema remained in the glottic area (Figures 3A,B), but it did not appear to markedly affect the patient's breathing, so the Montgomery T tube was removed (Figures 3C,D).