PMC7364183_01
Case 1 radiographs.. (
A) Post-intubation plain chest radiograph, on ICU on day 5 post-onset of symptoms. (
B) Plain chest radiograph on day 10 post-onset of symptoms.
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An 8-mm internal diameter endotracheal tube (ETT, Portex, Hythe, UK) was sited on first attempt with video-laryngoscopy, secured at 22 cm at the lips, with tip position subsequently confirmed on CXR ( Figure 1A) . Repeat CXR demonstrated no causative pathology ( Figure 1B).
Case 1 glottis images.. (
A) View of supraglottis showing ulcerated epiglottis. (
B) Glottis showing relative sparing of vocal cords and false cords, but profound subglottic oedema. (
C) Following change to size 6 endotracheal tube, there is some anterior glottic airway. (
D) However, the subglottis is also ulcerated and oedematous mucosa prevents rigid bronchoscopy (0
o Hopkins' rod) beyond the third tracheal ring. White arrows indicate areas of ulceration and red arrow subglottic oedema.
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The epiglottis was inflamed with shallow, irregular, ulcers ( Figure 2A). The rest of the supraglottis and superior surface of the vocal cords were spared, whilst profound oedema encased the ETT from cord level downwards ( Figure 2B). Hopkins' rod examination was now possible through the newly patent anterior glottis ( Figure 2C), but only as far as the fourth tracheal ring due to upper tracheal and subglottic oedema. Ulcers were present bilaterally in the subglottis ( Figure 2D).
PMC7364183_02
Case 2 radiographs.. (
A) Post-intubation plain chest radiograph, on day 1 of hospital admission. (
B) Day 5 following re-intubation.
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Initial CXR, Figure 3a. Subsequent CXR, Figure 3b.
Case 2 glottis images.. (
A) View of supraglottis showing ulcerated glottis. (
B) Glottis showing sparing of false cords, but profound glottic oedema and glottic and subglottic ulceration. (
C) Flexible bronchoscopy via the anterior commissure shows subglottic oedema and granulation tissue (black arrow). (
D) Oedematous mucosa prevents flexible bronchoscopy beyond the third tracheal ring. White arrows indicate areas of ulceration, black arrow granulation tissue and red arrow tracheal oedema.
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At microlaryngoscopy there was profound oedema in the glottis and subglottis ( Figure 4).