Prenatal MRI Findings of Fetuses with Congenital High Airway Obstruction Sequence

Carolina V. A. Guimaraes,Leann E. Linam,Beth M. Kline-Fath,Lane F. Donnelly,Maria A. Calvo-Garcia,Eva I. Rubio,Jeffrey C. Livingston,Robert J. Hopkin,Elizabeth Peach,Foong-Yen Lim,Timothy M. Crombleho 대한영상의학회 2009 Korean Journal of Radiology Vol.10 No.2

Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. Materials and Methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction. Objective: To define the MRI findings of congenital high airway obstruction sequence (CHAOS) in a series of fetuses. Materials and Methods: Prenatal fetal MR images were reviewed in seven fetuses with CHAOS at 21 to 27 weeks of gestation. The MRI findings were reviewed. The MRI parameters evaluated included the appearance of the lungs and diaphragm, presence or absence of hydrops, amount of amniotic fluid, airway appearance, predicted level of airway obstruction, and any additional findings or suspected genetic syndromes. Results: All the fetuses viewed (7 of 7) demonstrated the following MRI findings: dilated airway below the level of obstruction, increased lung signal, markedly increased lung volumes with flattened or inverted hemidiaphragms, massive ascites, centrally positioned and compressed heart, as well as placentomegaly. Other frequent findings were anasarca (6 of 7) and polyhydramnios (3 of 7). MRI identified the level of obstruction as laryngeal in five cases and tracheal in two cases. In four of the patients, surgery or autopsy confirmed the MRI predicted level of obstruction. Associated abnormalities were found in 4 of 7 (genetic syndromes in 2). Postnatal radiography (n = 3) showed markedly hyperinflated lungs with inverted or flattened hemidiaphragms, strandy perihilar opacities, pneumothoraces and tracheotomy. Two fetuses were terminated and one fetus demised in utero. Four fetuses were delivered via ex utero intrapartum treatment procedure. Conclusion: MRI shows a consistent pattern of abnormalities in fetuses with CHAOS, accurately identifies the level of airway obstruction, and helps differentiate from other lung abnormalities such as bilateral congenital pulmonary airway malformation by demonstrating an abnormally dilated airway distal to the obstruction.

Pharmacodynamic Estimate of Propofol-Induced Sedation and Airway Obstruction Effects in Obstructive Sleep Apnea-Hypopnea Syndrome

구본녀,한동우,신서경,김소연,강영란,정규희 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.5

Purpose: Sedatives must be carefully titrated for patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) as oversedationmay lead to disastrous respiratory outcomes. This study aimed to investigate the relations between the effect-site concentration(Ce) of propofol and sedation and airway obstruction levels in patients with OSAHS. Materials and Methods: In 25 patients with OSAHS, sedation was induced by 2% propofol using target-controlled infusion. Sedationand airway obstruction levels were assessed using the Observer’s Assessment of Alertness/Sedation Scale and a four-category scale, respectively. The relationships between propofol Ce and sedation and airway obstruction were evaluated using a sigmoid Emax model. Pharmacodynamic modeling incorporating covariates was performed using the Nonlinear Mixed Effects Modeling VII software. Results: Increased propofol Ce correlated with the depth of sedation and the severity of airway obstruction. Predicted Ce50(m) (Ce associated with 50% probability of an effect≥m) for sedation scores (m≥2, 3, 4, and 5) and airway-obstruction scores (m≥2, 3, and 4) were 1.61, 1.78, 1.91, and 2.17 μg/mL and 1.53, 1.64, and 2.09 μg/mL, respectively. Including the apnea-hypopnea index (AHI) as a covariate in the analysis of Ce50(4) for airway obstruction significantly improved the performance of the basic model (p<0.05). Conclusion: The probability of each sedation and airway obstruction score was properly described using a sigmoid Emax model with a narrow therapeutic range of propofol Ce in OSAHS patients. Patients with high AHI values need close monitoring to ensure that airway patency is maintained during propofol sedation.

Three Cases of Pierre Robin Sequence with Upper Airway Obstruction Relieved by Nasopharyngeal Airway Insertion

Min-Su Oh,Yu-Mi Park,Younghwa Jung,Chang Won Choi,Beyong Il Kim,권지원 대한신생아학회 2019 Neonatal medicine Vol.26 No.3

Pierre Robin sequence (PRS), also called Robin sequence, is a congenital anomaly characterized by a triad of micrognathia, glossoptosis, and upper airway obstruction. Infants with PRS can present with varying degrees of respiratory difficulty secondary to upper airway obstruction. There has been no consensus for the treatment of upper airway obstruction in infants with PRS, but recent studies recommend attempting non-surgical interventions before surgical treatment. In this case report, we present 3 cases of infants diagnosed with PRS who showed persistent respiratory difficulties after birth. Before considering surgical intervention, insertion of a nasopharyngeal airway was attempted in these infants. Following this procedure, symptoms of upper airway obstruction were relieved, and all infants were discharged without surgical interventions; the nasopharyngeal airway was removed 1 to 2 months later. To date, no infant has shown signs of upper airway obstruction. Nasopharyngeal airway insertion is a highly effective and less invasive treatment option for infants with PRS. However, it is not widely known and used in Korea. Nasopharyngeal airway insertion can be preferentially considered before surgical intervention for upper airway obstruction in such infants.

한국 성인 남성 폐쇄성 수면무호흡증 환자에서의 수면내시경 소견

홍성룡,이종길,이정훈,조규섭,노환중 대한이비인후과학회 부산,울산,경남 지부회 2012 임상이비인후과 Vol.23 No.2

Drug-induced sleep endoscopy (DISE) is one of the common techniques that visualize the upper airway dynamics during sleep in patients with obstructive sleep apnea (OSA). Authors tried to present the DISE results and to investigate the their relationship with polysomnography (PSG) findings. Materials and methods: Authors enrolled 31 male adults who were diagnosed with OSA between March 2011 and February 2012 at Pusan National University Yangsan Hospital. The data including age, body-mass index (BMI), Friedman staging, DISE findings and PSG results such as apnea-hypopnea index (AHI) and positional dependency were collected by retrospective chart reviews. Results:In DISE, 87.0% (27/31) showed the retropalatal airway obstruction and 48.4% (15/31) showed the retroglossal airway obstruction. Among them, 35.5% (11/31) showed obstructions in both the retropalatal and retroglossal airway. The retroglossal airway obstruction was not related with age, BMI or AHI but with Friedman’s palatal position and positional dependency (p=0.020 and 0.029, respectively). Conclusions:Freidman’s palatal position may be a good predictor of the retroglossal airway obstruction. This study suggests that a palatal airway surgery plus a positional therapy or a mandibular advancement device can be tried even in severe OSA patients with the retroglossal airway obstruction.

기도 폐색의 가역성 판정에서 기도 저항 측정의 의의

유철규,이상도,권오정,이춘택,한성구,심영수,김건열,한용철 서울大學校 醫科大學 結核硏究所 1990 結核硏究所 硏究報告 Vol.4 No.1

Severe Airway Obstruction due to Massive Retropharyngeal Hematoma in a Warfarin-Taking Patient with a Normal International Normalized Ratio

( Hyun Young Cho ),( Hyung Il Kim ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.1

Warfarin is used as part of the treatment of various diseases, and laboratory monitoring of its effects is required. Airway hematoma secondary to warfarin is rare, but can be fatal because of potential airway obstruction. Rapid definitive airway establishment is crucial if airway obstruction is suspected. This complication is more likely to occur in those with elevated coagulation laboratory values. However, we experienced a patient in whom a massive retropharyngeal hematoma caused airway obstruction after a non-severe motor vehicle collision. The patient had been taking warfarin, and had coagulation parameter values within the normal ranges. A major fracture or hemorrhage was not anticipated. Upon examination, a massive retropharyngeal hematoma was noted. Orotracheal intubation failed due to an airway obstruction. Emergency tracheostomy and an operation for hematoma removal were performed. Physicians must always consider the possibility of airway hematoma in warfarin-taking patients with normal coagulation values regardless of the severity of mechanism of injury.

비강충전으로 인한 코막힘을 줄일 수 있는 환기관의 고안

조남식,윤정희,김종엽,김민욱,최종철,윤영석 대한비과학회 2008 Journal of rhinology Vol.15 No.1

Background and Objectives:Nasal packing after nasal surgery is commonly practiced for various purposes including hemostasis, stabilization of nasal structure, and synechia prevention. However, the use of nasal packing has led to the development of uncomfortable symptoms such as nasal obstruction. In this study, therefore, we have devised a new method of nasal packing involving the use of an airway tube for reducing nasal obstruction and discomforts in association with post-surgical nasal obstruction. Materials and Methods:An airway tube was made by cutting the distal end of a 1cc syringe. It was inserted between the nasal septum and the packing material. Nasal cavities of 20 patients (Group 1) who underwent nasal surgery were packed using packing materials and the devised airway tubes following nasal surgery. We evaluated the symptoms of nasal obstruction after the postoperative nasal packing in this study group and compared them with those of the 20 patients (Group 2) who received packing with existing merocel nasal stents and 20 patients (Group 3) who were given packing with only merocel without airway tubes after nasal surgery. Result:In this study, nasal obstruction and discomforts in association with post-surgical nasal obstruction were significantly improved among patients given packing material and devised airway tubes (Group 1) comparative to other patient groups. Conclusion:Devised airway tube is useful in minimizing the symptoms of nasal obstruction and discomforts as well as in reducing surgical expense.

Air trapping is a major determinant of persistent airway obstruction in asthmatics

Park, S.W.,Park, J.S.,Jeong, S.H.,Lee, Y.N.,Hwangbo, Y.,Park, J.S.,Lee, J.H.,Jang, A.S.,Kim, D.J.,Uh, S.T.,Kim, Y.H.,Park, C.S. Baillière Tindall, in association with the 2012 Respiratory medicine Vol.106 No.6

Chronic persistent airway obstruction has been observed in moderate-to-severe asthmatics despite treatment with inhaled corticosteroids. We investigated which airway changes were associated with this obstruction. High-resolution computed tomography (HRCT) was performed at study entry and reexamined at the time of follow-up when the FEV1 reached a maximally constant level after treatment for 1 year or more with inhaled corticosteroids. Bronchial wall area and air trapping extent were compared in the recovered group (n = 18) and the persistent airway obstruction group (n = 14). Bronchial wall area and air trapping of the initial HRCT were similar between the two groups. On follow-up HRCT, air trapping was markedly decreased in the recovered group compared with that on initial HRCT (P = 0.017), whereas bronchial wall area did not change. In the persistent-airway-obstruction group, these two parameters did not change during follow-up. When follow-up HRCT was compared, air trapping was significantly greater in the persistent-airway-obstruction group than in the recovered group (P = 0.003). Difference post-bronchodilator FEV1 value between at initial and 2nd HRCT exam was correlated with difference air trapping value between at initial and 2nd HRCT exam(%) on the follow-up HRCT (P = 0.017). The presence of persistent airflow obstruction were significantly associated with the air trapping % difference between initial and 2nd time (RR = 1.70, P = 0.018). Persistence of AT could be a main contributing factor to chronic persistent airflow obstruction in asthma.

천명이 있으면서 정상 폐환기 기능 성적을 보인 천식 환자의 임상 분석

최인선,임호,고영일,정세웅 대한천식 및 알레르기학회 2004 천식 및 알레르기 Vol.24 No.1

Background : Wheezing is one of the characteristics of asthma. Intensity of wheezing is correlated with the severity of airway obstruction. However, some asthmatic patients may show wheezing despite normal ventilatory function. Objective : To determine the cause of wheezing in asthmatic patients with normal ventilatory function. Methods : Thirty-eight consecutive asthmatic patients with wheezing despite FEV 180% of predicted value were retrospectively examined for clinical data. Results : Twenty-seven patients (71.1%) were women. Sixteen patients (42.1%) showed airway obstruction based on the Intermountain Thoracic Society criteria. Patients with airway obstruction had significantly lower FEF50% than did those without it (F<.001). When the patients with no wheezing were re-examined by the pulmonary function test, 14 patients (48.3%) showed a significant bronchodilation. In patients without airway obstruction, FEF50/FIF50 was significantly higher than in those with it(F<.01). and FEF50/FIF50 >1 suggesting upper airway obstruction was observed in 7 of 16 (43.8%) patients. Associated diseases were rhinitis in 21 (55.3%) patients, sinusitis in 18 (47.4%), and postnasal drip syndrome in 3 (7.9%). Conclusions : Wheezing despite normal ventilatory function in asthma occurs more often in women. It may be related to reversible airway obstruction in nearly half patients and to upper airway obstruction such as rhinitis, in considerable numbers of the remaining patients. (J Asthma Allergy Clin Immunol 24 : 85-93, 2004)

The Efficacy of External Beam Radiotherapy for Airway Obstruction in Lung Cancer Patients

이정원,이종훈,김훈교,심병용,안호정,김성환 대한암학회 2015 Cancer Research and Treatment Vol.47 No.2

Purpose The objective of this study was to evaluate external beam radiotherapy (EBRT) in lung cancerpatients who suffer from airway obstruction. Materials and MethodsMedical data of 95 patients with a lung mass that obstructed the airway and received EBRTfor it were analyzed. Fifty-nine patients (62.1%) had non-small cell lung cancer and 36patients (37.9%) had small cell lung cancer. Radiotherapy was given at 8 to 45 Gy (median,30 Gy) in 1 to 15 fractions (median, 10 fractions). The response to EBRT was assessedthrough changes in radiographic findings and/or subjective symptoms between before andafter EBRT. The median follow-up duration was 124 days. The primary end point was theairway-obstruction resolving rate after EBRT. The secondary end points were patient survivaland toxic effects of EBRT. ResultsImprovement of airway obstruction after EBRT on chest X-ray was achieved in 75 of 95patients (78.9%). The median time for resolving the radiologic findings and/or symptomsof airway obstruction after EBRT was 7 days (range, 1 to 76 days). The 1-year survival ratewas significantly higher in responders than non-responders (12.5% vs. 0.0%, p < 0.001). The biologically effective dose of  39 Gy/=10 (p < 0.01) and the longest obstructive lesionof < 6 cm (p=0.04) were significantly associated with a good response to EBRT in resolvingthe airway obstruction. No one had grade 3 or higher acute and chronic toxicities. ConclusionEBRT is an effective treatment in relieving airway obstruction without severe toxicities inlung cancer patients.