176 AJTCCM VOL. 30 NO. 4 2024
PICK OF THE PICS
A 4-year-old child presented with stridor and respiratory distress.
Her mother reported that during re-insertion of the child’s
tracheostomy tube, the ange had broken o and the tube had
fallen into the trachea.
The tracheostomy had been inserted 3 years previously to
facilitate ventilation for complicated meningitis. e mother and
child were unfortunately lost to follow-up, and were still using the
original tracheostomy tube. Incidentally, the child was diagnosed
as HIV positive at this admission.
e child was admitted to the paediatric intensive care unit
and an urgent bronchoscopy was performed. A multidisciplinary
team, including otorhinolaryngology, cardiothoracic surgery
and paediatric pulmonology, was present, with the main concern
being access to the airway if there was upper airway obstruction.
Fortunately, the tracheobronchial tree could be accessed with
a exible bronchoscope inserted via a laryngeal mask. e size
3.0 tracheostomy tube was identied in the le main bronchus
and removed with grasping forceps introduced through the
working channel of a 3.5 mm exible bronchoscope, without
complications.
Is this airway safe?
C Jacobs,1 FC Paed (SA); P Goussard,1 FC Paed (SA), MMed (Paed), PhD; M Merven,2 FCORL (SA);
A Gie,1 FC Paed (SA), Cert Pulmonology (SA) Paed, PhD; S S B Venkatakrishna,3 MBBS; S Andronikou,3,4 FC Rad (SA) Diag, PhD
1 Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
2 Department of Otorhinolaryngology, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
3 Department of Radiology, Children’s Hospital of Philadelphia, Penn., USA
4 Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Penn., USA
Corresponding author: P Goussard (pgouss@sun.ac.za)
Fig. 1. Frontal (A) and lateral (B) chest radiographs in a 4-year-old
girl with HIV-related chronic lung disease demonstrate a long piece
of tracheostomy tubing that has broken o and is located in the distal
trachea and le main bronchus. ere are chronic ndings at both lung
bases – dense le basal atelectasis as well as dense right basal atelectasis
with bronchiectasis. e remainder of the lungs is hyperexpanded. An
artefact from clothing noted over the right mid-zone should not be
misinterpreted as disease.
AB
