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Correspondence to Dr Chirag Kamal Ahuja; [email protected]
Description
A 35-year-old male patient, tracheostomised for about 10 years, presented to our hospital with a dyspnoea of 2 days duration. There was a history of accidental decannulation of the tracheostomy tube recently. The cause for initial tracheostomy performed about a decade back was a subglottic stenosis following a prolonged intubation in an episode of scrub typhus with altered sensorium. Patient was however lost to follow-up after a few months of initial tracheostomy.
On evaluation, a stenosed stoma was seen at the tracheostomy site with no tube being visible externally. Suspecting accidental extubation, the stoma was revised for 7.5 mm cuffed tracheostomy tube and supportive management was initiated. The emergency chest radiograph had significant motion artefacts and hence unremarkable. Next day, the tracheostomy tube fixation was performed as planned with an endpoint of non-dyspnoeic clinical status. A non-contrast CT chest and neck (figure 1) with virtual bronchoscopy was done to assess the airway status. The freshly instilled tracheostomy tube was in situ. However, another tracheostomy tube was seen caudal to it contiguously from the internal opening of the fresh tube, snugly approximating to its orifice, inferiorly, its extent was beyond the carina, for up to...