PMC10139978_01
Chest CT findings (A) Plain CT (coronal section). (B) Three-dimensional reconstructed multi-masked bronchial CT. Continuous occupying material is observed from the main bronchi to the bronchioles. Diffuse frosted shadows are observed in both lung fields.. CT, computed tomography
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A computed tomography (CT) scan, which was obtained immediately after intubation, showed a continuously occupying substance located in the trachea and bronchi (Fig. 1).
Removed intratracheal substance.. Dendritic red mucus thrombus with a clear visualization of the bronchial tree in detail.
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The object was successfully removed by guiding the airway obstruction into the intubation tube using a bronchoscope and extubating the substance in one piece (Fig. 2, Fig. 3B).
Endoscopic view of the bronchial tube. (A, B)Bronchoscopic findings upon arrival at the hospital.. Material occupying the tracheal lumen and bleeding in the tracheal mucosa. (C, D) Bronchoscopy findings on day 4 after hospitalization. No new cast thrombus appeared, although intratracheal bleeding persists. (E, F) Bronchoscopy findings on day 7 of hospitalization. Intratracheal bleeding almost disappeared after steroid administration.
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To prevent pneumonia, sulbactam + ampicillin was administered, and daily bronchoscopy was performed to evaluate the airway; however, exudative bleeding persisted in the trachea (Fig. 3C and D). Since the P/F ratio was 120, acute respiratory distress syndrome was diagnosed, and prednisolone 62.5 mg/day was started, resulting in improved respiratory status and intratracheal bleeding (Fig. 3E and F).
Pathological findings of dendritic red mucus thrombus.. Hematoma is composed of coagulum and fibrin, with no epithelial components. Mucus and inflammatory cell infiltrates, including macrophages and neutrophils, are present. No neoplastic changes or malignant findings are observed. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Other mucus components and an infiltration of inflammatory cells were also present, including macrophages and neutrophils (Fig. 4).