Entübasyon zorluğuna neden olan tonsiller lipoma: Olgu sunumu
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
Tonsillar lipoma causing difficult intubation: a case report
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.
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- Begin LR, Frenkiel S. Polypoid lipoma of the palatine tonsil. J Laryngol Otol 1993;107:556-8.
- Heffner DK. Pathology of the tonsils and adenoids. Otolaryngol Clin North Am 1987;20:279-86.
- Rosenberg A, Bone and joint, soft tissue tumors. In: Cotran RS, Kumar V, Robbins SL, editors. Robbins pathologic basis of disease. 5th ed. Philadelphia: W. B. Saunders; 1994. p. 1216-1268.
- Tsunoda A. Lipoma in the peri-tonsillar space. J Laryngol Otol 1994;108:693-5.
- Friedman M, Tanyeri H, La Rosa M, Landsberg R, Vaidyanathan K, Pieri S, et al. Clinical predictors of obstructive sleep apnea. Laryngoscope 1999;109:1901-7.
- Ovassapian A, Glassenberg R, Randel GI, Klock A, Mesnick PS, Klafta JM. The unexpected difficult airway and lingual tonsil hyperplasia: a case series and a review of the literature. Anesthesiology 2002; 97:124-32.
- Day LH, Arnold GE. Rare tumors of the ear, nose and throat: second series: uncommon benign tumors of the head and neck. Laryngoscope 1971;81:1138-74.
- Benson-Mitchell R, Tolley N, Croft CB, Roberts D. Lipoma of the left tonsillar fossa. J Laryngol Otol 1994; 108:507-8.
- Pitts DB, Hilsinger RL Jr. Retronasopharyngeal lipoma: a case report. Otolaryngol Head Neck Surg 1989; 100:248-51.
- Said-Al-Naief N, Zahurullah FR, Sciubba JJ. Oral spindle cell lipoma. Ann Diagn Pathol 2001;5:207-15.
- Fregnani ER, Pires FR, Falzoni R, Lopes MA, Vargas PA. Lipomas of the oral cavity: clinical findings, histological classification and proliferative activity of 46 cases. Int J Oral Maxillofac Surg 2003;32:49-53.
- Harada H, Kashiwagi S, Morimatsu M, Kameyama T, Takahashi M. Tonsillar lipoma: a case report. J Laryngol Otol 1995;109:662-4.
- Persaud RA, Kotnis R, Ong CC, Bowdler DA. A rare case of a pedunculated lipoma in the pharynx. Emerg Med J 2002;19:275.
- Davies S, Ananthanarayan C, Castro C. Asymptomatic lingual tonsillar hypertrophy and difficult airway management: a report of three cases. Can J Anaesth 2001;48:1020-4.
- Kapur TR. Recurrent lipomata of the larynx and the pharynx with late malignant change. J Laryngol Otol 1968;82:761-8.
- Saddik M, Oldring DJ, Mourad WA. Liposarcoma of the base of tongue and tonsillar fossa: A possibly underdiagnosed neoplasm. Arch Pathol Lab Med 1996;120:292-5.
- ISSN: 2602-4837
- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1991
- Yayıncı: İstanbul Üniversitesi
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