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A Rare Case of Iatrogenic Deep Neck Infection Secondary to Hypopharyngeal Injury Caused by the Transesophageal Echocardiography.

Kim HY, Lee SC, Park SJ, Choi JO, Chang SA, Kim SM, Choe YH, Oh JK, Park SW - J Cardiovasc Ultrasound (2015)

Bottom Line: Transesophageal echocardiography (TEE) is considered relatively safe but semi-invasive.The patient recovered uneventfully.For cardiologists performing TEE, it is required to know complications and their risk factors to minimize hypopharyngeal and esophageal injury.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Transesophageal echocardiography (TEE) is considered relatively safe but semi-invasive. The hypopharyngeal and esophageal injury is infrequent complication of TEE but could be serious, even life-threatening. We present a case of a 74-year-old man who experienced a deep neck infection secondary to hypopharyngeal injury following TEE. The diagnosis was made because of the subcutaneous emphysema developed 3 hours after TEE. In spite of antibiotics therapy with prolonged fasting, a right parapharyngeal and retropharyngeal abscess was developed 5 days later. With ultrasound-guided drainage of abscess and continuous antibiotic treatment, infection was controlled. The patent underwent mitral valve repair after 14 days of antibiotic therapy. The patient recovered uneventfully. For cardiologists performing TEE, it is required to know complications and their risk factors to minimize hypopharyngeal and esophageal injury.

No MeSH data available.


Related in: MedlinePlus

Transesophageal echocardiography revealed severe eccentric mitral regurgitation with mitral valve prolapse (A3-P3 commissure).
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Figure 1: Transesophageal echocardiography revealed severe eccentric mitral regurgitation with mitral valve prolapse (A3-P3 commissure).

Mentions: The patient was admitted to the intensive care unit because of uncompensated heart failure and careful control of pulmonary edema with chronic kidney disease. We performed transthoracic echocardiography with subsequent TEE to comprehensive evaluation of mitral valve disease. The patient presented tachypnea and orthopnea before the TEE procedure, less than minimal dose of sedative agent was administrated to lessen patient's discomfort, 1 mg of lorazepam, 25 mg of fentanyl, intravenously. As we checked for the mental status, the patient was not sedate, before and during the insertion of TEE probe. The insertion of TEE probe was performed with the patient in left lateral decubitus position according to the following standardized technique: the probe was inserted through the midline and gently advanced to pass the first pharyngeal curvature corresponding to the base of the tongue. The probe was then extended, and the patient was asked to swallow, at which point the probe was further advanced to enter the esophageal inlet. When the probe has reached to the root of tongue, the patient suddenly changed his position form left decubitus to supine position and gave force to the neck, and resisted to probe insertion. The probe got lodged at right-side of hypopharyngeal area so that failed to advance. At second attempt, TEE probe was advanced into esophagus easily during swallowing with patient's cooperation. TEE demonstrated severe eccentric MR with medial commissural prolapse due to chordae rupture (A3-P3 commissure) with left ventricular dilatation, mild tricuspid regurgitation (Fig. 1).


A Rare Case of Iatrogenic Deep Neck Infection Secondary to Hypopharyngeal Injury Caused by the Transesophageal Echocardiography.

Kim HY, Lee SC, Park SJ, Choi JO, Chang SA, Kim SM, Choe YH, Oh JK, Park SW - J Cardiovasc Ultrasound (2015)

Transesophageal echocardiography revealed severe eccentric mitral regurgitation with mitral valve prolapse (A3-P3 commissure).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4595706&req=5

Figure 1: Transesophageal echocardiography revealed severe eccentric mitral regurgitation with mitral valve prolapse (A3-P3 commissure).
Mentions: The patient was admitted to the intensive care unit because of uncompensated heart failure and careful control of pulmonary edema with chronic kidney disease. We performed transthoracic echocardiography with subsequent TEE to comprehensive evaluation of mitral valve disease. The patient presented tachypnea and orthopnea before the TEE procedure, less than minimal dose of sedative agent was administrated to lessen patient's discomfort, 1 mg of lorazepam, 25 mg of fentanyl, intravenously. As we checked for the mental status, the patient was not sedate, before and during the insertion of TEE probe. The insertion of TEE probe was performed with the patient in left lateral decubitus position according to the following standardized technique: the probe was inserted through the midline and gently advanced to pass the first pharyngeal curvature corresponding to the base of the tongue. The probe was then extended, and the patient was asked to swallow, at which point the probe was further advanced to enter the esophageal inlet. When the probe has reached to the root of tongue, the patient suddenly changed his position form left decubitus to supine position and gave force to the neck, and resisted to probe insertion. The probe got lodged at right-side of hypopharyngeal area so that failed to advance. At second attempt, TEE probe was advanced into esophagus easily during swallowing with patient's cooperation. TEE demonstrated severe eccentric MR with medial commissural prolapse due to chordae rupture (A3-P3 commissure) with left ventricular dilatation, mild tricuspid regurgitation (Fig. 1).

Bottom Line: Transesophageal echocardiography (TEE) is considered relatively safe but semi-invasive.The patient recovered uneventfully.For cardiologists performing TEE, it is required to know complications and their risk factors to minimize hypopharyngeal and esophageal injury.

View Article: PubMed Central - PubMed

Affiliation: Division of Cardiology, Department of Medicine, Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

ABSTRACT
Transesophageal echocardiography (TEE) is considered relatively safe but semi-invasive. The hypopharyngeal and esophageal injury is infrequent complication of TEE but could be serious, even life-threatening. We present a case of a 74-year-old man who experienced a deep neck infection secondary to hypopharyngeal injury following TEE. The diagnosis was made because of the subcutaneous emphysema developed 3 hours after TEE. In spite of antibiotics therapy with prolonged fasting, a right parapharyngeal and retropharyngeal abscess was developed 5 days later. With ultrasound-guided drainage of abscess and continuous antibiotic treatment, infection was controlled. The patent underwent mitral valve repair after 14 days of antibiotic therapy. The patient recovered uneventfully. For cardiologists performing TEE, it is required to know complications and their risk factors to minimize hypopharyngeal and esophageal injury.

No MeSH data available.


Related in: MedlinePlus