Can Intubate but Not Ventilate Nightmare – Mounier-Kuhn Syndrome- Case Report
Ana Jurin Martic, Martina Selec.
The Mounier-Kuhn syndrome (MKS) or tracheobronchomegaly (TBM) is a rare condition of unknown frequency, only 300 cases have been reported [1,2]. It is characterized by significant expansion of the trachea and bronchi and recurrent respiratory infections [3,4]. Our patient was a 60-year-old male with pneumonia, admitted to ICU due to the urge for mechanical ventilation. Ventilation by mask was normal, he was intubated without any difficulty, but mechanical ventilation was impossible due to enormous leakage, bag valve ventilation was only option to deliver any tidal volume. Bronchoscopy revealed the collapse of the distal trachea and the left main bronchus, mucous plaque was removed. Tamponade of the larynx reduced the leakage. MSCT of the neck was made, tracheomegaly and bronchomegaly were described; Mounier Kuhn syndrome was suspected. Further bronchoscopy revealed mucoid impactions filling the bronchi of the lower right lobe. He was weaned and extubated, but oxygenation worsened despite of HFNC, so he was reintubated with larger tracheal tube. Further ventilation was carried out without leakage, a percutaneous tracheotomy was performed 15 days later and he was gradually weaned from mechanical ventilation.
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