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Imzil A, Bounoua F, Amrani HN, Moubachir H, Serhane H. Tracheobronchomegaly (Mounier-Kuhn Syndrome) with CT and bronchoscopic correlation: A case report. Radiol Case Rep 2022; 17:3611-3615. [PMID: 35923343 PMCID: PMC9340121 DOI: 10.1016/j.radcr.2022.06.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 06/12/2022] [Accepted: 06/21/2022] [Indexed: 11/26/2022] Open
Abstract
Tracheobronchomegaly, or Mounier-Kuhn syndrome, is a clinical and radiological entity characterized by marked dilatation of the trachea and bronchi as a result of severe atrophy of the elastic fibers, with thinning of the muscularis, and the formation of diverticula between the cartilaginous rings. The etiopathogenesis is uncertain and may be congenital or acquired. The clinical signs are not specific and are frequently revealed by recurrent respiratory infections and chronic cough. The diagnosis of Mounier-Kuhn syndrome is based on well-documented measurements of the trachea and main bronchi performed on a chest computed tomography scan. The management of patients is based on symptomatic treatment and may require, in severe cases, the use of endoscopic treatment by stent placement or surgical tracheobronchoplasty. We present a case of a 59yearold patient with recurrent respiratory infections that required several hospitalizations. Diagnosed with Mounier Kuhn syndrome, the thoracic computed tomography scan demonstrated a dilated trachea until the bifurcation and focal points of bronchial dilatation. Bronchoscopic examination showed a dilated and deformed trachea with the presence of diverticula on the tracheal anterior wall. The diameter of the trachea was reduced by more than 50% during expiration and coughing. For this reason, Mounier-Kuhn syndrome should be considered in cases of recurrent respiratory infection or persistent respiratory symptoms.
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Collins NE. Acquired Tracheomegaly in Critically Ill Patients With COVID-19: A Literature Review. J Nurse Pract 2022; 18:857-861. [PMID: 35812350 PMCID: PMC9253918 DOI: 10.1016/j.nurpra.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Tracheomegaly is defined as an abnormally dilated trachea and is seen in patients requiring long-standing mechanical ventilation and/or significant hyperinflation of their endotracheal or tracheostomy tube cuffs can occur in adults with severe COVID-19. Tracheomegaly is linked with inadequate nutrition, pneumonia, diabetes, hypotension, steroids, and protracted mechanical ventilation, which are common in COVID-19 patients. Findings include cuff leaks that necessitate cuff overinflation to maintain adequate tidal volumes. Tracheomegaly can be diagnosed with chest radiographs, chest computed tomography, bronchoscopy, or diagnostic laryngoscopy or tracheoscopy. This condition leads to a concern for obstruction, airway collapse, aspiration pneumonia, and iatrogenic tracheal injuries.
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Choudhury S, Chohan A, Taweesedt PT, Dadhwal R, Vakil A. Coronavirus Disease 2019-Induced Tracheomegaly: A Case Report. Cureus 2022; 14:e23810. [PMID: 35518539 PMCID: PMC9067324 DOI: 10.7759/cureus.23810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/17/2022] Open
Abstract
Tracheomegaly is a medical condition where the tracheal diameter is greater than the upper limits of normal. Tracheomegaly can be classified as primary or secondary. Primary tracheomegaly is usually congenital. Secondary tracheomegaly can be due to multiple causes, including connective tissue disease, infections, autoimmune diseases like sarcoidosis, and prolonged mechanical ventilation. Here, we describe the first reported case of tracheomegaly secondary to coronavirus disease 2019 (COVID-19) pneumonia and COVID-induced interstitial lung disease (ILD). While many cases of tracheomegaly are asymptomatic, patients can have symptoms like cough, dyspnea, hemoptysis, or even respiratory failure. Tracheomegaly is associated with a higher risk of recurrent lower respiratory tract infections, chronic cough, bronchiectasis, and tracheobronchomalacia. Early recognition of COVID-19-induced tracheomegaly can help initial early management and reduce the incidence of infections.
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An Accidental Discovery of Tracheobronchomegaly: a Case Report. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
AbstractTracheobronchomegaly is a rare disease with congenital abnormal change in respiratory tract; its image features are also very special. In this case, we described a 57-year-old male with cough, expectoration, chest pain, and dyspnea. In our institution, the result of chest CT scan is highly extraordinary, which showed obvious dilation of the trachea and main bronchi, emphysema, and a number of pulmonary bullae, and there was a big bulla with air-fluid level on the lower lobe of the right lung. Fortunately, after wedge resection for the big bulla on the lower lobe of right lung under video-assisted thoracoscopic surgery, this patient’s symptoms were significantly relieved. The clinical manifestations of tracheobronchomegaly lack specificity; this disease has freakish image features. At present, there are no effective treatments for tracheobronchomegaly, which just was an accidental discovery in this patient; we just mainly take surgical measures to treat the big bulla for relieving symptoms.
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Rjimati M, Serraj M, Elbiaze M, Benjelloun MC, Amara B. Mounier-Kuhn syndrome (Tracheobronchomegaly): Radiological diagnosis. Radiol Case Rep 2021; 16:2546-2550. [PMID: 34276851 PMCID: PMC8271099 DOI: 10.1016/j.radcr.2021.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 11/04/2022] Open
Abstract
Mounier Kuhn Syndrome or tracheobronchomegaly is a rare disease, characterized by dilatation of the trachea and the main bronchi. Our study concerns a case of 67-years old male patient, smoker, with a chronic cough. Chest scan was requested; it shows an enlargement of the tracheal clarity and the two main bronchi. Meanwhile, the Functional respiratory exploration was normal. The treatment includes mucolytics and pulmonary physiotherapy. Mounier-Kuhn syndrome is rare and the clinical signs are not specific, the positive diagnosis is purely radiological. The treatment is about to free the airways to prevent infection.
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Affiliation(s)
- M Rjimati
- Department of Pulmonology, University Hospital Center Hassan II, Fez, Morocco, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - M Serraj
- Department of Pulmonology, University Hospital Center Hassan II, Fez, Morocco, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - M Elbiaze
- Department of Pulmonology, University Hospital Center Hassan II, Fez, Morocco, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - M C Benjelloun
- Department of Pulmonology, University Hospital Center Hassan II, Fez, Morocco, Sidi Mohammed Ben Abdellah University, Fes, Morocco
| | - B Amara
- Department of Pulmonology, University Hospital Center Hassan II, Fez, Morocco, Sidi Mohammed Ben Abdellah University, Fes, Morocco
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[The GELF is over, long live the GETIF!!]. Rev Mal Respir 2021; 38:131-133. [PMID: 33581984 DOI: 10.1016/j.rmr.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/28/2021] [Indexed: 11/22/2022]
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Harper S, Robinson M, Manning G, Jones A, Hobson J, Shelton CL. Management of tracheostomy-related tracheomegaly in a patient with COVID-19 pneumonitis. Anaesth Rep 2020; 8:e12076. [PMID: 33210094 DOI: 10.1002/anr3.12076] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2020] [Indexed: 11/06/2022] Open
Abstract
Acquired tracheomegaly is a rare condition associated with pulmonary fibrosis, connective tissue disease and the use of cuffed tracheal tubes. We describe the urgent tracheal re-intubation and subsequent tracheal repair of a previously well 58-year-old man who developed tracheostomy-related tracheomegaly during prolonged mechanical ventilation for coronavirus disease 2019 pneumonitis. Urgent tracheal re-intubation was required due to a persistent cuff leak, pneumomediastinum and malposition of the tracheostomy tube. We describe the additional challenges and risks associated with airway management in patients with tracheomegaly, and discuss how even in urgent cases these can be mitigated through planning and teamwork. We present a stepwise approach to tracheal re-intubation past a large tracheal dilatation, including the use of an Aintree catheter inserted via the existing tracheal stoma for oxygenation or tracheal re-intubation if required. Computed tomography imaging was valuable in characterising the defect and developing a safe airway management strategy before starting the procedure. This report emphasises the role of planning, teamwork and the development of an appropriate airway strategy in the safe management of complex cases.
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Affiliation(s)
- S Harper
- North West School of Anaesthetics Health Education England North West Manchester UK
| | - M Robinson
- North West School of Anaesthetics Health Education England North West Manchester UK
| | - G Manning
- Department of Anaesthesia Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK
| | - A Jones
- Department of Anaesthesia Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK
| | - J Hobson
- Division of Surgery Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK
| | - C L Shelton
- Department of Anaesthesia Wythenshawe Hospital Manchester University NHS Foundation Trust Manchester UK.,Lancaster Medical School Faculty of Health and Medicine Lancaster University Lancaster UK
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Bismuth J, Habert P, Boyer A, Palot A. Évaluation par tomodensitométrie thoracique d’un traitement de la trachéobronchomalacie par pression positive continue dans le cadre d’un syndrome de Mounier–Kuhn. Rev Mal Respir 2020; 37:748-751. [DOI: 10.1016/j.rmr.2020.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/10/2020] [Indexed: 11/25/2022]
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Dunne B, Lemaître P, de Perrot M, Chaparro C, Keshavjee S. Tracheobronchoplasty followed by bilateral lung transplantation for Mounier-Kuhn syndrome. JTCVS Tech 2020; 3:400-402. [PMID: 34317944 PMCID: PMC8302864 DOI: 10.1016/j.xjtc.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 03/28/2020] [Accepted: 04/02/2020] [Indexed: 11/27/2022] Open
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Satia I, Dua B, Singh N, Killian K, O'Byrne PM. Tracheobronchomegaly, cough and recurrent chest infection: Mounier-Kuhn syndrome. ERJ Open Res 2020; 6:00138-2020. [PMID: 32613017 PMCID: PMC7322912 DOI: 10.1183/23120541.00138-2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 03/25/2020] [Indexed: 11/24/2022] Open
Abstract
A 49-year-old male ex-smoker was referred for recurrent chest infections requiring one course of antibiotics every winter, occurring over the last 20 years. Each episode is characterised by a productive cough with purulent sputum along with difficulty breathing, chest tightness and fatigue, but without haemoptysis. On some occasions, these symptoms were preceded by fever and rhinorrhoea. Each episode lasted ∼10 days and responded well to antibiotics. He had never been hospitalised for these infections, nor received a chest radiograph or sputum microbiology. He had been told that he developed episodes of pneumonia in his first year of life. Apart from these yearly infections, the patient was asymptomatic during the rest of the year. Mounier-Kuhn Syndrome (MKS) is a rare disease characterised by recurrent chest infections, and dilation of the trachea and main bronchi, most likely to due to atrophy of elastic fibreshttps://bit.ly/3azhDjr
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Affiliation(s)
- Imran Satia
- McMaster University, Dept of Medicine, Division of Respirology, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
| | - Benny Dua
- McMaster University, Dept of Medicine, Division of Respirology, Hamilton, Canada
| | - Nina Singh
- McMaster University, Dept of Medicine, Division of Respirology, Hamilton, Canada
| | - Kieran Killian
- McMaster University, Dept of Medicine, Division of Respirology, Hamilton, Canada
| | - Paul M O'Byrne
- McMaster University, Dept of Medicine, Division of Respirology, Hamilton, Canada.,Firestone Institute for Respiratory Health, St Joseph's Healthcare, Hamilton, Canada
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Wegner F, Barkhausen J. CT of Mounier-Kuhn Disease. Radiology 2020; 294:246. [DOI: 10.1148/radiol.2019191791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Franz Wegner
- From the Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Joerg Barkhausen
- From the Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Chughtai AR, Agarwal PP. Tracheobronchomalacia in the Adult: Is Imaging Helpful? CURRENT PULMONOLOGY REPORTS 2019. [DOI: 10.1007/s13665-019-00228-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chenbhanich J, Villa-Camacho J, Konter J. A case of tracheobronchomegaly. Eur J Intern Med 2017; 42:e7-e8. [PMID: 28109701 DOI: 10.1016/j.ejim.2017.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 01/11/2017] [Indexed: 11/27/2022]
Abstract
Tracheobronchomegaly (Mounier-Kuhn syndrome) is a rare condition characterized by an abnormally enlarged trachea and main bronchi. Herein, we present a case of 79-year-old male with idiopathic pulmonary fibrosis and acute hypoxemic respiratory failure due to multilobar pneumonia. Computed tomography of the chest demonstrated a markedly dilated trachea, with the transverse diameter of 31mm and the sagittal diameter of 30mm. The clinical manifestations as well as its diagnosis, classification, and treatment are discussed.
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Affiliation(s)
- Jirat Chenbhanich
- Department of Internal Medicine, Metrowest Medical Center, 115 Lincoln St, Framingham, MA 01702, USA.
| | - Juan Villa-Camacho
- Department of Internal Medicine, Metrowest Medical Center, 115 Lincoln St, Framingham, MA 01702, USA.
| | - Jason Konter
- Department of Internal Medicine, Metrowest Medical Center, 115 Lincoln St, Framingham, MA 01702, USA; Division of Pulmonary and Critical Care Medicine, Metrowest Medical Center, 115 Lincoln St, Framingham, MA 01702, USA.
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