Tension ball valve mucus plug in asthma.

Area of Science:

• Pulmonology
• Critical Care Medicine

Background:

• Status asthmaticus can lead to respiratory failure requiring mechanical ventilation.
• Mechanical ventilation in severe asthma can present unique complications.

Observation:

• A patient with status asthmaticus on mechanical ventilation developed profound hypoxemia.
• Absent breath sounds and a hyperlucent left hemithorax with mediastinal shift were noted on examination and chest radiography.

Findings:

• Radiographic lung markings ruled out tension pneumothorax.
• Diagnosis of tension mediastinal shift due to a central mucus plug causing ball-valve obstruction was made.
• Bronchoscopic lung lavage successfully removed the mucus plug.

Implications:

• This case highlights a previously undescribed acute complication of mechanical ventilation in status asthmaticus.
• Early recognition of this complication is crucial to differentiate it from tension pneumothorax.
• Prompt bronchoscopic intervention can resolve the obstruction and improve hypoxemia.