Total airway occlusion in a parturient with a mediastinal mass after anesthetic induction--a case report

A 26-year-old primigravida having suffered from dry cough, dyspnea and orthopnea for two months came to our hospital for a check up at 34 weeks gestation. Physical examination and ultrasonic study showed a lot of lymph nodes around her neck. After close coordination of opinion from responsible doctors, it was decided to deliver the baby first. After anesthetic induction, bronchoscopy revealed that the lower trachea was totally collapsed with obvious tracheobronchial mucosal swelling. A high inspiratory pressure was applied, and high-dose corticosteroid and bronchodilator were immediately given, but the airway resistance was still high and her SpO2 level was falling down. Fortunately, after we changed the patient's position from supine to semi-sitting, ease of ventilation was reestablished and SpO2 rose up from 40% to 100%. We then delivered a healthy baby, and malignant lymphoma was proven by biopsy of the cervical lymph nodes performed immediately after delivery. In this case, the change to semi-sitting position and relevant medication helped reestablish her ventilation and save her life. At the moment we write she is undergoing chemotherapy and does her follow-up at our hospital as advised.