Compression of the Left Main Bronchus Between a Descending Thoracic Aortic Aneurysm and an Enlarged Right Pulmonary Artery: Case Report
Physical examination revealed a toxic, cachectic looking man in moderate respiratory distress. His blood pressure was 100/60 mm Hg, his pulse rate 100/min, and his respiratory rate 28/min. His temperature was 36.9°C. He was using his accessory muscles and had intercostal indrawing. The anteroposterior diameter of his chest was increased. The left side of his chest was dull to percussion and breath sounds were diminished. A few scattered crackles were present over the right upper lobe.
His WBC was 22,000 mm with the differential revealing a left shift. His hemoglobin was 103 g/L with microcytic indices. A chest radiograph (Fig 1) showed nearly complete radiopacity of the left hemithorax with volume loss. Small radiolucent areas were seen near the periphery of the lung. His arterial blood gas revealed a P02 of 66 mm Hg, a PCO2 of 50 mm Hg with a pH of 7.44 on 3 L of oxygen delivered by nasal prongs. A room air arterial blood gas after his last exacerbation had revealed a P02 of 65 mm Hg and а Рсог of 50 mm Hg.
A left main obstruction with a postobstructive pneumonia was suspected. He was started on cefuroxime 750 mg IV every 8 hours and was transferred to the medical ward. Unfortunately, before bronchoscopy could be performed, he had a respiratory arrest. Buy ventolin inhaler further An orotracheal airway was established and mechanical ventilation initiated. He was then transferred to the medical intensive care unit. After stabilization bronchoscopy was performed. The left main bronchus was noted to be markedly narrowed as a result of bulging of both the anterior and posterior walls. Purulent secretions were seen coming from below the obstruction on the left and from the right side of the tracheobronchial tree as well. The bronchoscope could not be passed below the obstruction. In the bronchoscopist’s opinion, the left mainstem narrowing was from extrinsic compression. A thoracic computed tomography scan was obtained (Fig 2) and showed that the left-main bronchus was indeed compressed between an aneurysm of the descending thoracic aorta (about 5X6.5 cm) and an enlarged right pulmonary artery (32 mm).
Figure 1. A chest radiograph taken shortly after intubation showing a radiopaque area indicating left hemithorax with volume loss.
Figure 2. Computed tomography scan showing compression of the left main bronchus between an aneurysm of the descending aorta and an enlarged right pulmonary artery (arrow).
Category: Respiratory Symptoms
Tags: aortic aneurysm, pulmonary hypertension, tracheobronchial compression