Difficult airway by hematoma of the thongue in a patient on anticoagulant therapy

España Fuente, L.

doi:10.1016/j.redare.2020.06.017

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B y C) Engrosamiento de la lengua que provoca un «efecto masa» debido al edema y hematoma de la misma (punta de flecha) que oblitera casi por completo la luz de la orofaringe. A) Estrechamiento de la orofaringe observándose una mínima luz filiforme de aproximadamente 3-4 mm (flecha)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L. España Fuente" "autores" => array:1 [ 0 => array:2 [ "nombre" => "L." 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España Fuente" "autores" => array:1 [ 0 => array:3 [ "nombre" => "L." "apellidos" => "España Fuente" "email" => array:1 [ 0 => "lorenespana@yahoo.es" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Anestesiología y Reanimación, Hospital Universitario San Agustín, Avilés, Asturias, Spain" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Vía aérea difícil por hematoma lingual en paciente anticoagulado" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 908 "Ancho" => 2917 "Tamanyo" => 221335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Nasopharyngeal image (A and C) and cervical (B and C) CT scan showing thickening of the tongue causing a “mass effect” due to oedema and haematoma (arrowhead) that almost completely obliterates the lumen of the oropharynx. (A) Narrowing of the oropharynx, showing a thin filiform lumen of approximately 3–4 mm (arrow)." ] ] ] "textoCompleto" => "A 62-year-old patient, height 1.77 cm and weight 90 kg, with a body mass index (BMI) of 28.7, taking anticoagulation therapy with rivaroxaban for atrial fibrillation, was admitted with respiratory distress due to a sublingual haematoma (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Computed tomography (CT) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) showed swelling of the base of the tongue that caused a “mass effect” in which tongue itself occupied most of the oral cavity and almost completely obliterated the lumen of the oropharynx (arrowhead), leaving a small filiform lumen 3–4 mm in diameter (arrow). The absence of active bleeding confirmed the diagnosis of haematoma with significant oedema that did not extend to other compartments of the neck.<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia>Faced with the risk of a “cannot intubate, cannot ventilate” situation due to the size of the oedema, the rapid and progressive deterioration of spontaneous ventilation, and in view of the patient’s anatomy, which permitted easy identification of the laryngeal cartilages, we decided to perform an urgent percutaneous tracheostomy." "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: España Fuente L. Vía aérea difícil por hematoma lingual en paciente anticoagulado. Rev Esp Anestesiol Reanim. 2021;68:306–307." ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 621 "Ancho" => 1250 "Tamanyo" => 166574 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "The oral cavity of the patient, showing the swelling caused by oedema and haematoma that made it impossible to visualise the tip of the tongue. The swelling also restricted mouth opening." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 908 "Ancho" => 2917 "Tamanyo" => 221335 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Nasopharyngeal image (A and C) and cervical (B and C) CT scan showing thickening of the tongue causing a “mass effect” due to oedema and haematoma (arrowhead) that almost completely obliterates the lumen of the oropharynx. 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ISSN: 2341-1929

Revista Española de Anestesiología y Reanimación (REDAR) -the Spanish Journal of Anesthesiology and Resuscitation- is the scientific body of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy. This is a monthly journal (10 issues) that publishes scientific articles of all areas within its specialty: clinical anesthesia, resuscitation-intensive medicine and critical care, diagnosis and treatment of acute and chronic pain, urgent care and emergencies and studies on basic science and related fields. The journal accepts work in both Spanish and English.

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