Tonsillar lipoma causing difficult intubation: a case report

Yıl 2007, Cilt: 17 Sayı: 6, 329 - 332, 24.11.2007

Fevzi Sefa Dereköy Hüseyin Fidan Fatma Fidan Fatma Aktepe Orhan Kemal Kahveci

Öz

A 63-year-old woman with confusion and disorientation was referred to the Pulmonary Medicine Department of Afyon Kocatepe University. She was uncooperative and her peripheral oxygen saturation was 75%. She was on diuretic therapy for heart failure. An emergency intuba­ tion was planned due to the development of respiratory acidosis and hypoxemia, but the patient could not be intubated. After several attempts, intubation was suc- cessful only by digital manipulation of a lateral pharyn- geal mass noticed incidentally. She was inadvertently extubated on the third day of intubation and an emer­ gency tracheotomy was performed. Otolaryngological examination revealed a mass originating from the right palatine tonsil, and a computed tomography scan shovved a hypodense mass extending from the uvula to the epiglottis. Under general anesthesia, the patient undervvent a right tonsillectomy and a lipomatous mass 3.6x3.2x2.2 cm and the palatine tonsil 3.5x1.1x0.8 cm were resected. Microscopically, the tumor con- sisted of mature adipocytes with thin fibrous septae. İt should be borne in mind that patients may be unavvare of a tonsillar mass that may lead to serious dyspnea and difficult intubation.

Anahtar Kelimeler

İntubation, intratracheal, lipomaü tonsillar neoplasms/pathology/surgery

Entübasyon zorluğuna neden olan tonsiller lipoma: Olgu sunumu

Öz

Konfüzyon ve oryantasyon bozukluğu olan 63 yaşın- da kadın hasta Afyon Kocatepe Üniversitesi Göğüs Hastalıkları bölümünde incelendi. Kooperasyon kurulamayan hastanın periferik oksijen konsantras- yonu %75 idi. Kalp yetmezliği tanısıyla diüretik tedavisi alıyordu. Respiratuvar asidoz ve hipoksemi nedeniyle acil entübasyon planlanmasına karşın hasta entübe edilemedi. Birkaç denemeden sonra, tesadüfen görülen lateral farengeal kitlenin par- makla ekartasyonu sonrasında entübasyon yapıldı. Entübasyonun üçüncü gününde istenmeden ekstübe edilen hastaya acil trakeotomi girişimi yapıldı. Kulak burun boğaz muayenesinde görülen, sağ palatin tonsilden kaynaklanan kitle, bilgisayarlı tomografide uvuladan epiglottise kadar uzanan hipodens bir kitle olarak görüntülendi. Hastaya genel anestezi altında tonsillektomi uygulandı ve lipom 3.6x3.2x2.2 cm ve palatin tonsilden 3.5x1.1x0.8 cm oluşan kitle alındı. Tümör mikroskobik olarak olgun adipozitlerden ve ince fibröz septalardan oluşmaktaydı. Sonuç olarak, hastanın varlığından habersiz olduğu bir tonsiller kitlenin dispne ve entübasyon zorluğuna yol açabile- ceği akılda tutulmalıdır

Anahtar Kelimeler

Entübasyon, intratrakeal, lipom, tonsil neoplazileri/patoloji/cerrahi

Kaynakça

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