PMC4961798_01
(A) A chest radiograph at presentation showed a fractured metallic tracheostomy tube in the left main bronchus. (B) Bronchoscopic view of the fractured tube in the left main bronchus. (C) Balloon catheter technique to remove the fractured tube. (D) The fractured outer cannula of the metallic tracheostomy tube; severe corrosion at the fracture site is noted.
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fig1
At a suburban hospital, a chest radiograph was performed and disclosed a metallic density foreign body in his left main bronchus (Fig. 1A). The fractured outer cannula tube was found lodged in the left main bronchus (Fig. 1B). The catheter was gently pulled up, which hooked the tube along with it (Fig. 1 C), until reaching the tracheostomy stoma; the rigid bronchoscope tube, flexible bronchoscope, balloon catheter, and fractured tube were then withdrawn simultaneously through the stoma. Inspection of the fractured metallic TT showed severe corrosion at the neck and mild corrosion at the body of the outer cannula tube, while the inner tube was intact (Fig. 1D).
Metallic tracheostomy tubes before (A) and after (B) 6 months of saliva submersion; (1) is a silver-plated brass tracheostomy tube, (2) is a stainless steel tracheostomy tube.
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fig2
TT, we simulated the situation mimicking the routine use of a TT. Two types of metallic TT are commonly used in Thailand: the first, as in this case, is made of stainless steel (Premier ; Premier Medical Products, Plymouth Meeting, PA), and the second is made of silver-plated brass (QMC ; Qureshi Manufacturing Corp., Sialkot, Pakistan) (Fig. 2A). Six months later, both the inner and outer tube of the silver-plated brass TT showed mild corrosion, while the stainless steel TT remained unchanged (Fig. 2 B).