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Spannungspneumothorax nach akuter Atemwegsverlegung bei pulmonaler Aspergillose

Tension pneumothorax after acute airway displacement due to pulmonary aspergillosis

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Zusammenfassung

Die akute lymphatische Leukämie ist die häufigste maligne Erkrankung im Kindesalter und birgt bei der Durchführung von Allgemeinanästhesien krankheitsspezifische Risiken, die zu lebensbedrohlichen Komplikationen führen können. Es wird über einen 14-jährigen Jungen berichtet, der im Rahmen der Chemotherapie eine Aspergillose entwickelte. Aufgrund eines zerebralen Rundherdes sollte eine offene Biopsie durchgeführt werden. Bereits kurz nach der Narkoseeinleitung entwickelten sich Zeichen einer ausgeprägten pulmonalen Obstruktion. Erst durch den Wechsel des Endotrachealtubus konnte ein koagelartiger Fremdkörper geborgen werden, der mit Aspergillus-Hyphen durchsetzt war und die Tubusspitze ventilartig verlegte. Ein dadurch bedingter einseitiger Spannungspneumothorax musste mithilfe einer Bülau-Drainage entlast werden. Anhand dieser lebensbedrohlichen und bislang nichtbeschriebenen Komplikation einer pulmonalen Aspergillose werden die geeignete Vorbereitung und Durchführung einer Allgemeinanästhesie bei diesem Krankheitsbild diskutiert.

Abstract

Acute lymphoblastic leukaemia is the most common malignancy in childhood. This disease and its associated therapy may lead to specific life-threatening complications if general anaesthesia has to be carried out. The case of a 14-year-old boy suffering from aspergillosis because of immunosuppression in the course of chemotherapy is reported. Due to a cerebral round lesion an open biopsy was required. After induction of anaesthesia, severe pulmonary obstruction developed. After exchange of the endotracheal tube a coagulum-like foreign body interspersed with Aspergillus hyphae obstructing the distal aperture in a valve-like manner could be recovered. The resulting unilateral tension pneumothorax had to be relieved with a closed pleural drainage. With reference to this as yet unreported life-threatening complication of pulmonary aspergillosis, the appropriate preparation and conduction of general anaesthesia are discussed.

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  1. Klinik und Poliklinik für Anästhesiologie, Universitätsklinik Würzburg, Würzburg, Deutschland

    C. Söllmann, H. Trautner, T. Papenfuß, M. Lange & N. Roewer

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  1. C. Söllmann
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  2. H. Trautner
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  3. T. Papenfuß
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  4. M. Lange
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  5. N. Roewer
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Correspondence to C. Söllmann.

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Söllmann, C., Trautner, H., Papenfuß, T. et al. Spannungspneumothorax nach akuter Atemwegsverlegung bei pulmonaler Aspergillose. Anaesthesist 58, 602–606 (2009). https://doi.org/10.1007/s00101-009-1558-4

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  • DOI: https://doi.org/10.1007/s00101-009-1558-4

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